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Thursday, November 8, 2012

If McDonald's was like your Pharmacy

People always act as if pharmacies are fast food joints. We do have drive-thrus. We also have a dollar menu (okay, it's more of a free, $4, $10 menu but you get the gist). To help people understand the differences, however subtle, I have written the following guide:   If Mcdonald's was my Pharmacy...

-You would need to visit a doctor to make sure you need the meal you are here to purchase.
-Your doctor would write you a prescription for the exact meal and quantities you need today (no ordering a la carte or upsizing without prior authorization).
-Your order, after being entered into the touchscreen, would generate individual receipts (read:labels) for each item on your order (fries, apple pie, quarter pounder, Coke). This is provided, of course, that he can read the doctor's directions. Even though the doctor only had to circle a picture of the sandwich he wanted, he managed to circle two pictures (one from the dollar menu and one from the regular menu). Now she will have to call the doctor for clarification. 
-One person would then take these receipts (labels) to fill your order. He would pour a pile of fries on a tray and count them to get you the prescribed amount. He would use a graduated cylinder to pour you the correct volume of your beverage and count out the ice cubes for each cup. The quarter pounder would be weighed out on a scale or balance to ensure accuracy. Each of these would then have its own receipt (label) attached to it.
-The manager would receive the tray from the filling station. She would scan the receipt to bring up an image of the food product you ordered and make sure it matches what is in her hand. She would check the order, one item at a time, to make sure it exactly matches what the doctor ordered (wouldn't want to forget an order of hash browns first thing in the morning) and to make sure they can all be eaten at the same time (no interactions). She would also check to make sure you didn't forge any refills on the Coke or change the small fry to a large fry--you know, to prevent abuse. Then your history would pop up on the screen. She could see if you always get this order or if your doctor changed something since your last visit. She would also check your medical history to make sure you are healthy enough to receive today's meal. (Heart problems?-No Big Mac for you. Diabetes?-No Diet Coke. High Cholesterol?-No fries with that!) She would also check with other chains to make sure you are not getting these meals prescribed by another doctor and using two different fast food chains for the same thing. She wouldn't want you to accidentally overdose on cheeseburgers because they're called something else at Burger King and you didn't tell her you just filled an order there. If you are healthy enough, your food moves down the line. If not, we have to call your doctor to ask why he prescribed this particular meal for you. In some cases, he may tell us you need the large fries and a milkshake, but she will tell him it needs prior authorization through your insurance. Once he calls for the prior authorization and the insurance calls him back (usually 24-72 hours later--long wait for lunch!) either to approve the large fries or change the prescription to apple slices, your order will move on.
-Now your order proceeds to checkout. We give you a cash total. It's the first of the month/year and your insurance has changed but you didn't provide it immediately. The cashier takes the new information and hands it off to someone else for correction and an update to your file. She hands the tray back to the checkout person who tells you the new copay, collects the copay from you, then smiles and says "Have a nice day!".
-Refills on beverages will not be authorized without a new order from your physician.
-Medicaid patients will have copays and the formulary will only include items on the $4 and $10 menus board. This means no milkshakes, no medium or large sized portions, and no sundaes. 
-All the while, every person involved in your order in the back- the person cooking, dropping a basket of fries, wrapping the sandwiches, pouring drinks, waiting on drive-thru-is also answering the phone that is ringing off the hook. At this McDonald's, doctors are phoning/faxing/electronically sending in orders for other hungry diners. There are hungry diners sitting at home calling in orders they want to pick up later or checking to see if their doctor called in their orders yet, or calling for our hours. The manager is also out administering espresso shots to those who have prescriptions for caffeine because she is required to do so. She is also walking out to help people find the bathroom, the condiments, the napkins, the trash can, and a place to sit all in the name of good customer service. (She's not allowed to just point to the stand behind the customers and say "everything is right there.")
-Drive-Thrus. Remember, drive-thrus are about convenience, not speed! What takes so long, then? It can actually take longer because managers are required to do counseling if someone asks and if they ask at the drive-thru the wait can seem interminable. When this happens, the manager patiently, expertly demonstrates how to open a straw, insert it into the "X" cut into the plastic lid, and use it to deliver himself a mouthful of ice cold beverage. He then demonstrates how to properly open a packet of ketchup and apply it to your burger as well as the proper method to dip fries into it. Next, he'll answer a question about the appropriate number of bites to take for this particular sandwich and how much mastication is required for each bite. 
-When the fries look different, the patient may be confused. It is up to the manager to patiently explain that this is McDonald's, not Wendy's, so there is not skin on the fries here. He will also have to explain why the wrapper looks different (different burger joints use different wrappers) or why they may have changed colors (the new Christmas cups are in at McDonald's).

Everybody got it? Please remember this the next time you visit either of our establishments and maybe it will change your perception.   

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