The Power of Community and America’s Pharmacists

I live in a community – that is, a community as opposed to say, a home made up of a nuclear family or a couple. I suppose it’s an unusual way to live. None of my friends or family members live in communities and I suspect that some of them regard my lifestyle as strange. But looking back over my life I see that I have always tried to create community in one way or another. From my days living in Chicago and San Francisco, then back to my home town of Albuquerque I have lived in seven different communal households, some successful and some dysfunctional, but always interesting and always, always enlightening.

If you look up the word “community” in the dictionary you will find one of its meanings is “a unified group of individuals”. Indeed, in my experience only the communities that come together over one unifying philosophy or practice thrive. People who cannot bridge their differences see only how they are not alike and those differences become wedges that drive them apart. But when individuals come together on common ground great things can happen. People linked by a common viewpoint can build the support system necessary to reach goals they could not accomplish on their own. There is, as they say, a definite power in numbers.

The pharmacy profession is under intense pressure these days. All 50 states have the same law: There must be a pharmacist present when a prescription is dispensed to the patient. This is, according to pharmacist and writer Jim Plagakis, the bedrock issue that defines pharmacists, and that definition is being challenged. Pharmacists all over the country complain about a workload that not only causes stress and inconvenience for individuals on both sides of the counter but actually endangers the lives of pharmacy patients. Pharmacy Benefit Managers (PBMs) have created a bureaucracy that exists only to drive profits and ultimately takes control out of the hands of pharmacists. Big chains cut pharmacy staffs to the bone resulting in prescription avalanches that justify implementing mail-order service or automation. The push, in other words, to cut pharmacists out of the process of dispensing prescription drugs all together is on, and with a vengeance.

The saving grace of the pharmacy profession lies in its untapped potential. As the author of The Redheaded Pharmacist blog has said, pharmacists are the “sleeping giants” of the medical field. Despite their rigorous education and expertise they are relegated mostly to the tasks of dispensing and distributing prescription drugs. Instead, their role could be expanded to protect public health by overseeing programs to advocate and administer vaccinations, to run cholesterol checks, blood pressure screenings, and to manage drug regimens for HIV or cancer patients. Few physicians take the time to make sure their patients understand the drugs they prescribe, so most Americans are dreadfully ignorant when it comes to the drugs they take. As the true drug experts, pharmacists should also be counselors. They are capable of much more than handing out information sheets and asking if patients have questions. They could help hospital patients understand the drugs they are given at a time when illness or injury makes them particularly vulnerable. They could counsel chronic patients outside the hospital to manage their drug treatments properly. They could even lobby for a class of behind-the-counter medications which they prescribe and dispense, taking pressure off physicians for the management of some conditions and cutting costs for the healthcare system by giving the patients the tools to better manage themselves.

Pharmacists are aware that their talents are under-utilized. Movements to give pharmacists greater responsibilities exist all over the country and models like Medication Therapy Management (MTM) are poised for institution and ready to go. But MTM remains on the shelf and pharmacy clinics are few and far between. The key to granting greater responsibility to pharmacists permanently is legislative change. Yet legislative change does not come easily and the wheels of the American Pharmacists Association (APhA), the largest association of pharmacists in the United States, grind exceedingly slow. The solution, at least in part, goes back to the discussion of community. Community – the coming together of pharmacists over the idea that they can and should play an expanded role in the medical field – could serve as the much needed vehicle of change.

Community IS powerful but making it a living, breathing reality is tricky. The call to change is certainly out there; problems and possible solutions are in every professional blog and online publication. In Alcoholics Anonymous is it said that the chances of making a lasting change before hitting bottom are practically nil. If that’s true, then what is the bottom for pharmacists? Pharmacists are notorious for not organizing and for better or for worse, unions are no longer popular in the American psyche. Only 11.9% of the country’s workers belong to one, according to the Department of Labor. A lot of pharmacists don’t see there’s much to be gained by joining a union. Many feel it would be wrong to strike under any circumstances. Others feel unions are only interested in their own political agendas. Still, most agree that yes, something must be done.

About 60,000 pharmacists belong to the APhA – less than one quarter of the total of about 270,000 pharmacists who are employed in the US. The APhA launched its initiative, Project Destiny, in 2008, designed to develop a “replicable, scalable, measurable, and economically viable future model for community pharmacy.” Although involved in establishing a new role for pharmacists, many see them as detached from the everyday problems that plague the profession. State organizations and local boards of pharmacy are not regarded any more highly; pedantic and made up of political appointees, they lack the perspective of pharmacists on the front lines and do little to address their grievances.

“Real change,” said President Obama, “comes from the bottom up, the grass roots, starting with the dreams and passions of individuals…” The same can be said for any group, any community. First there must be a common dream of how things could be, then a passion to do what’s necessary to make that real. It should be obvious to pharmacists by now that organization leaders aren’t going to do it. It will take a huge wave of fed-up pharmacy professionals who have hit their bottom and care enough about the profession to work for change. Let’s hope they’ll hit that bottom and bounce back without bottoming out – and soon.

 

 

 

 

A Pharmacist Walks Into a Bar….

I write a blog about pharmacy. So I read a lot of pharmacist’s blogs and from what I read, pharmacists have to deal with a lot of stupid people – customers, managers, doctors, nurses, patients. Not all people in these categories are stupid, of course, but the ones who are seem always to gravitate to the pharmacist. Apparently, pharmacists are whiners. They whine about their jobs, their hours, their customers, their managers. Whine, whine, whine. The Blonde Pharmacist writes, “How many other jobs can you sit on your ass and look at the computer screen all day making sure things are right and make six figures? Not many. Stop whining!!!”

No, I’m not a pharmacist. But I have worked with the public. I’ve always found that outrageous behavior on the part of the public and of my colleagues was normal. Not only that, but the outrageous behavior could be expected to become more outrageous over time. So whine, pharmacists, whine! The absolutely-I-cross-my-heart-and-hope-to-die true stories below show you deserve it:

A pharmacist, wearing his white CVS coat, is waiting for the bus outside a Wegman’s pharmacy that is under construction. A customer is staring at sheets of plastic covering the construction area where the pharmacy used to be. Attached to the plastic is a sign stating the pharmacy’s new location. Looking the CVS pharmacist up and down, the customer asks, “What time is the Pharmacy going to open?” The pharmacist’s mouth falls open. He points to the sign. “Yeah?” says the customer. “How am I supposed to get my prescriptions?”

(Whimper.)

The actor Walter Matthau once said, “I always wanted to be a pharmacist. I liked the way our local pharmacist was always dressed in a nice white coat; he looked very calm. You’d give him money and he’d give you something that you wanted to buy.” Uh-huh. And my mom wore pearls to vacuum the house just like Mrs. Cleaver…..

Speaking of Mrs. Cleaver, calm pharmacy environments and clean white coats are as far gone as my daddy’s 1956 Ford Fairlane: Ring-ring. “It’s a great day at Wright’s Pharmacy! Can I help you?” “Uh – yeah. I – uh…I threw up a little while ago and uhh…well, I threw up my Oxycontin and they’re the ones with the OC on them and uh, I was wondering…is it OK if I take them again?”

(Moan.)

Cut to the guy standing next to the pharmacy counter staring at the plastic pill organizers. Pharmacist: “Can I help you, Sir?” Customer: “Yeah. I lost my seven-day pill box this morning.” “OK,” thinks the pharmacist, “I’ll bite. What happened to it, Sir?” “You see,” said the customer, “I filled my box with all my medications for the week. Then I put it in the microwave and set it on high for five minutes. I do not know why I did that.” The pharmacist is sure that she does not know why, either. “After it dinged, I saw that everything had melted together. I tried to suck up the liquid with a straw, but then the straw melted, too. Now I guess I need a new box to hold everything together.”

Digesting that….uh, yeah, a new box to hold your new prescription for Haldol.

Ring-ring. “Thank you for calling Walgreen’s at Main and Pine. This is Jim. May I help you?” “Where are you located?” (OK, no need to get upset – just count to ten.) ”At the intersection of Main and Pine, Ma’am.”

“Are you open?”

(Sigh.)

A pharmacist is heading down the aisle of the Rite-Aid on his way out for lunch. A customer spots him and grabs his jacket. “Can I get the 12 hour Allegra over the counter?” “Sure,” says the pharmacist. “We have the 12 hour and the 24 hour. Still want to stick to the 12 hour?” “Dunno,” says the customer, looking worriedly up and down the shelves. “What’s the difference?”

!!!!!!

Ring-ring. The pharmacist picks up the phone. “How much is 5 grams in a teaspoon?” asks the woman on the line. Now, this is not a question the pharmacist hears very often. Turns out the woman picked up a prescription for metronidazole vaginal gel but accidentally threw away the applicator. She figured a spoon would work just as well. Thing is, she just didn’t know how much 5 grams in a spoon was. The visual on this was not pleasant – a spoon and a hoo-hoo and all, but since this was a compounding pharmacy the pharmacist offered some free applicators at no charge. Nice recovery.

(Groan.)

Ring-ring. “Thanks for calling Ocean View Pharmacy. How can I help?”

“What number is this?”

(………………..)

A man comes up to the counter. “I need some Naproxen – 500mg.” “Well,” says, the pharmacist, “Naproxen 500mg is prescription only but we have some over the counter in about half that dose.” The man looks blankly at the pharmacist and turns to go down the pain reliever aisle. “How can 500mg be prescription only if you have this on the shelf?” the man shouts. He holds up a box of Tylenol.  The pharmacist gestures the man back to the counter where he explains that Tylenol and Naproxen are not the same thing. “Oh, no,” says the man. “That’s not right. My mother takes Naproxen 500mg and it comes in a bottle just like this and this is what she wants.” “But Sir,” explains the pharmacist, “there is absolutely no Naproxen in this product.” “This is what she wants,” says the man. “This and only this. How much?”

(Whine.)

And then there’s the story of the night pharmacist. It’s 3 am. Ring-ring. “Good morning. May I help you?” Caller (sobbing): “I have some medication I got at the pharmacy *sob* and the instructions say to take it with a glass of water *sob*.” Pharmacist: “Yes, Ma’am, that’s right.” Caller: “I’m so worried! *sob* I took the pill but I only had half a glass of water at the time! *sob* Is that OK?” The pharmacist collects himself. “Ma’am, did you swallow the pill completely or is it caught in your throat?” Caller: “*sob* I think it’s in my belly.” Pharmacist: “Then everything is OK, Ma’am – this time.” Caller: *sniffle* “OK, good night.”

(Yikes.)

Yes, pharmacists – it’s true. You have plenty to whine about. I mean, you can’t make this stuff up! Somebody did make this next story up, though – a little classic pharmacist humor to brighten your day. Egad! You need it!

A lady walked into a drugstore and told the pharmacist that she needed some cyanide right away. The pharmacist, naturally concerned by such a request, asked, “Why in the world do you need cyanide?” The lady explained that she needed it to poison her husband. The pharmacist’s eyes got big and he said, “I can’t give you cyanide to kill your husband! That’s against the law! I’ll lose my license! They’ll throw both of us in jail and our lives will be over! Absolutely not! No cyanide!” The lady reached into her purse and pulled out a picture of her husband in a passionate embrace with the pharmacist’s wife. “Well, now,” said the pharmacist. “You didn’t tell me you had a prescription.”

Happy Dispensing!

(PS – Pharmacists and other health professionals: Do you have a story like this? If so, send it to me at cvh55@apexmedicalplacements.com. We’d love to print it!)

Slouching Toward Compromise – The Access to Birth Control Act

In high school I was a member of the Speech Club and the debating team. One of our favorite topics, both in class and in competition, was abortion – partly because it was emotional and made for lively discussion, but mostly because it was a question that could never be resolved. Now, some 40 years later, abortion is still hotly debated in the U.S. Emotions run higher than ever; doctors who perform them have been murdered. Women who have them have been harassed. Politicians have attempted to make end-runs around the Roe v Wade decision, which made them legal in 1973. But despite all the arguments one thing is sure: the question of abortion is still has no definitive answer.

Enter Representative Carolyn Maloney of New York and Senator Frank Lautenberg of New Jersey. Last week they introduced the Access to Birth Control (ABC) Act to Congress following the release of an Institute of Medicine (IOM) report recommending that birth control be made available without co-pays because of its importance for women’s preventive health care. The Access to Birth Control Act would prevent pharmacies from denying the sale of contraceptives based on a pharmacy employee’s religious beliefs.

Pharmacist bloggers have had plenty to say about the pending legislation. One complained about the tone of the articles he had read about the bill, saying that the organizations supporting it had painted a negative picture of the pharmacy profession. “You would think,” wrote the Redheaded Pharmacist, “there were widespread refusals to fill prescriptions by an entire band of rogue pharmacists if you read these news reports. Painting the picture that pharmacists routinely judge patients or make moral decisions for them at work is simply misguided and wrong!” I’m sure that the Redheaded Pharmacist is right when he asserts that the vast majority of pharmacists don’t mix their personal ideologies with their professional ethics. But his characterization of the bill’s supporting organizations illustrates some of the high emotions surrounding this issue. Not all pharmacists may routinely judge patients, yet the problem of pharmacists refusing access to birth control products is widespread enough to warrant attention by lawmakers. According to the Guttmacher Institute, women in at least 24 states have reported being denied access to birth control and emergency contraception. “The issue of pharmacies refusing to fill prescriptions for contraceptives came to light in 1996,” says NorthJersey.com, “when a pharmacist was fired from a Cincinnati Kmart after refusing to fill a prescription due to her own religious beliefs. Refusals have been documented in 19 other circumstances in several states, including Texas, Wisconsin and Massachusetts.” The problem, while perhaps not routine, is no longer unusual. And the pharmacists involved , while perhaps not a rogue band, are certainly representative of the current political climate in this country – one in which the right of a woman to make decisions regarding her own health has come under attack.

When individual rights are threatened, what is the remedy? The Redheaded Pharmacist, for one, doesn’t believe the federal government should have a role: “I have two words for Rep. Carolyn Maloney and Sen. Frank Lautenberg: state’s rights! The regulation of pharmacies and the requirements of pharmacists to practice should be a state oversight and not a federal issue.” The Roe V Wade decision addresses the issue of state’s rights in this case directly – in 1973 the Supreme Court struck down state laws that made abortion illegal. Legal access to abortion is, in other words, the law of the land. Since some religious views equate contraception with abortion, six states have stepped in with laws that require pharmacies to fill women’s birth-control prescriptions, despite the beliefs of individual pharmacists. But in the end a piecemeal approach to defining the scope of Roe v Wade isn’t practical. Challenges to federal law, whether from individuals or state legislatures, must be met on the federal level.

“This bill is critical because it ensures that every woman will be able to leave her pharmacy with her medication in hand and her dignity intact,” said Marcia D. Greenberger, Co-President of the National Women’s Law Center. The concept is simple – women should be able to walk into a pharmacy and leave with the medication they need. Although the Centers for Disease Control and Prevention included family planning in its published list of the “Ten Great Public Health Achievements in the 20th Century”, the United States still has one of the highest rates of unintended pregnancies among industrialized nations. Each year, 3,000,000 pregnancies, nearly half of all pregnancies, in the United States are unintended, and nearly half of unintended pregnancies end in abortion. Contraception is one of the best ways to prevent unintended pregnancy and reduce the need for abortion.

The ABC Act would require pharmacies to help, not hinder a woman’s ability to access contraception. Should the Redheaded Pharmacist or anyone else believe that the federal government is overreaching, consider this: a report by the Guttmacher Institute reveals that in the first six months of 2011, states enacted 162 new provisions related to reproductive health and rights. Fully 49% of these new laws seek to restrict access to abortion services, a sharp increase from 2010, when 26% of new laws restricted abortion. The 80 abortion restrictions enacted this year are more than double the previous record of 34 abortion restrictions enacted in 2005—and more than triple the 23 enacted in 2010. All of these new provisions were enacted in just 19 states.

While some pharmacists’ kneejerk reaction to the bill may be one of unwanted government interference, the bill actually gives pharmacists something to be grateful for. According to Representative Maloney’s own website the ABC Act protects the right of an individual pharmacist to refuse to fill a prescription by ensuring that pharmacies will fill all prescriptions, even if a different pharmacist has to do it: “By placing the burden on the pharmacy, the ABC Act strikes a balance between the rights of individual pharmacists who might have personal objections to contraception and the rights of women to receive their medication.”

Despite the controversy, the ABC Act is a bright spot in an otherwise dark picture for women’s reproductive freedom. The nature of that freedom will always resist definition because it is highly personal in nature, but this legislation gives us the hope that effective compromises can be reached. It is a reminder from the federal level to pharmacies and patients alike that because we are a nation of laws, and not men, the gulf between diverse positions can be bridged to serve the interests of those on both sides of any issue. Hooray for us.