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Sunday, October 11, 2020

You Are Going To Die

I am going to kill you.
Perhaps it won't be me, but it will be a pharmacist. 
Perhaps it won't be you, but it will be someone you know and love. 
When the authorities and lawyers and judges and family members ask what happened, I will have to accept responsibility. 
It will most likely kill me to know something I did at work, which could have been prevented, directly contributed to your loss. 
When those people dig deeper in an attempt to discover how this mistake could have occurred, they will only find gossamer-thin whispers of leads that will ultimately end in a cul-de-sac around the pharmacist, around me. 
We all understand the ultimate responsibility for a mistake ends with the pharmacist; the buck stops here and all that drivel. 
What if you are put into a losing situation? 
What if the circumstances in which you work are beyond your control? 
You can only control what you can control. 
What if you are set up to fail? 
Does anyone care? 
No. No one except your pharmacist. 
Who is doing her best despite the deck stacked against her. 
When any error occurs, whether at your home or in my pharmacy, the common response is to identify the error, discover how it occurred, implement a plan to prevent another error of this type, and learn from it. It's how we evolve.
Pharmacists must self-report errors made.
Reporting errors in the pharmacy brings about two major results: a citation from the company and a lawyer making sure the company is safe from a lawsuit.
When we report errors, there is a question on the form: "What caused the error?"
The reply of "distractions and not enough help" is met with a scoff from the powers-that-be.
Do they attempt to fix it?

I have spoken truly about what takes place in the pharmacy. On the most basic level, we enter, count, fill, and check prescriptions. That has always been the job. Over the years, new tasks and distractions have been added to our workload, each one increasing the chance for a mistake to occur.
Phones ring off the hook. With corporate-mandated automatic outgoing phone calls, patients call to ask why they received a call or a text. We have to sell products and services. We offer immunizations. We are in an open area of the pharmacy where patients can just shout at us their questions. Drive-thru lanes that ring incessantly are a distraction upon one's focus and concentration.
Walk into any pharmacy and count the number of bodies behind the counter and match that with the number of stations available.
(Stations include: Drop off window, pick up window, consultation window, drive-thru window, Data Entry workstation, Counting workstation, Pharmacist checking station, and anywhere from 3-10 phone lines available.)
The employees are stretched thin but the corporate budget predicts the amount of help necessary to man the battle stations. Their numbers can't be wrong, right?
While manning all of these stations, sometimes multiple stations at once, your pharmacist is also checking your prescription for mistakes. Imagine reading a book in a crowded bar with a DJ playing music, a few friends trying to include you in the conversation, your phone going off as your kids are trying to locate you, someone tapping you on the shoulder every few minutes excusing themselves past you on their way to the loo, and random shouts of "GOAL" echoing from the match on the telly.
How much of what you were reading do you remember?
How many times did you restart that page, that paragraph, that sentence?
This is the life your pharmacist leads.
This is the life into which you put your life.
She is set up to fail and one day it will kill someone.
It will not be anyone's fault she couldn't remember what she read on that last page in her book, your prescription.
Except hers.
She is set up to fail.
Until pharmacies work to change their work environments for their employees, someone is going to die. Unfortunately, I believe it is going to take such an event to occur before changes happen. Pharmacies will file it under "cost of doing business".
Shouldn't you want something better for yourself, for your loved ones than to be considered a "cost of doing business"?

Focus is paramount in our profession. We are the last line of defence between your prescriber and an awful day.
Now another scenario for you. Imagine yourself lying on an operating table. We've all seen the movies where the staff are all in their precise locations, assisting with the procedure, monitoring the monitors. We usually have a surgeon, assistant, nurse, tech, and anesthesiologist. Each person has a specific job to do. Now imagine the hospital cut the staff in the OR down to just the surgeon and one nurse. Someone has to hand the surgeon his instruments. Someone has to monitor the vitals. Someone has to administer the anesthesia. Someone has to prep the patient and be on hand for calling in help when needed.
As the procedure starts and these two lonesome souls are wrists deep in your chest cavity, the phone rings in the OR and the surgeon has to answer it because the nurse stepped aside to call for a radiologist. Someone needs to know what's taking so long and where the vending machine is located in the waiting room. Oh, and a family member just poked her head in the door asking "how much longer?' because they have dinner reservations in 10 minutes.
Is this a most absurd scenario? A professional team being decimated to save a few dollars for the hospital?
Is this what your pharmacists and their teams deal with on a daily basis?
Is this an exaggeration?
No. Not really at all.
For 12 hours a day this is what we do with skeleton crews.
Is that the environment in which you want your pharmacy staff to work?
Apparently it is because patients like to yell and scream at the pharmacy staff for taking too long and don't consider the repercussions if their interruptions lead to a mistake.
Until someone dies, no one will care.
Except your pharmacist.
Unfortunately, when I discover I killed you, my life will end.
I will not be able to live with myself knowing what I did.
I will have to surrender my licence and leave the profession I love.
The pharmacy? No remorse.
Maybe a statement from their media mouthpiece about "thoughts and prayers" and how "that pharmacist no longer works for us".
But that's it.
They won't change a damn thing.
Until we demand it.
Actually, until YOU demand it.
Your pharmacists have been demanding it for years. But they don't listen to us. In their eyes, we are not smart enough to understand budgets and staffing demands.
I don't want to kill you.
I don't want to hurt you or anyone you love.
Please understand this.
I am going to kill you.
I don't want to, but it will happen.

Friday, October 9, 2020


CPP: What's got your knickers in a knot? 
CP: Maskholes. 
CPP: Eh? 
CPP: The people who believe they have been ordained as judge, jury, and executioner in the proper wearing of masks. Suddenly people who never had to wear one are self-appointing themselves as the mask police. 
CP: Have you ever accidentally seen someone naked? That's like mask-free time in the pharmacy.
CPP: I'm just going to sit over here and let you, you know, do your thing. 
CP: <inhales deeply> It started with people telling me my techs need to stop touching their masks, or pulling them outward to talk. Then we were visited by the ghost of Christmas Present, the Health Department. Funny how they were wearing neck gaitors instead of real masks, but that's not for me to judge (wink). It has now become a point of contention with regards to customer complaints. "The pharmacist should not be behind the counter without her mask." Really? Why? I hate to break it to you but, and this may be shocking, I am a human being. I need to eat. I need to drink. I'm not allowed to take a break. It must be nice to work in a place that allows you to take breaks for these necessities. Me? I'm stuck back here for 12 hours a day. (And before any of you say it, this is NOT what I signed up for in college and it has certainly changed over the previous 6 months. Also, NO, FYI, I am NOT compensated to put up with people passing judgement on me and criticising MY mask wearing.) 
Where was I? 
Right. Where I stand is more than 6 feet from my counter. It is far enough away from my staff that I can eat and drink without regard to my mask status. News flash, when I am alone in the pharmacy, before or after hours, I may take off my mask. Why? Because I can replace it when someone comes to my counter. I'm not going to wear it at home just in case someone comes by to ring my bell and pop over for a visit. Same with work. My nose runs more during the day when I wear my mask. I must remove it to address the issue with a tissue. I'm pretty certain my white mask would look weird with a brown hole in the middle if I were forced to drink my morning Starbucks through the mask. 
CPP: Don't you just love how 6 months ago we were essential?
CP: FIGHTING to be considered essential, as I remember it. 
CPP: Right. But people were thanking us for being there for them and now? 
CP: Now they are back to yelling and screaming because we are too slow or our masks may be off for the short period it takes to blow a nose or eat a Cheeto. Hell, even our normal complaints are tainted with some dig at our mask etiquette.
CPP: I really think your post about "taking a snapshot in the pharmacy" is relevant here. My old preceptor never wore her lab coat. The days when she put it on, our boss would walk in about 10 minutes after. Her partner always wore his coat. He'd take it off on a warm day and that's when the bosses would stroll into the pharmacy. You can't capture the entire scene from one photograph of one second in the pharmacy. 
CP: True. But it doesn't stop people from judging us. I really wish we were considered healthcare professionals. 


Thursday, October 8, 2020

Case Study

CP: We should change our pharmacy's name. 
CPP: To what? 
CP: Justin. 
CPP: That's it? 
CP: That's it. 
CPP: Why just Justin? Why not Justin's Tinctures and Tonics? Or Justin's PharmaCity? Or whatever other weird crap has fallen out of that gourd of yours over the years.
CP: Because Justin is much more apropos. 
CPP: Ok. I'll bite. . . rabbit hole, here we go. 
CP: We are "just in" for everything. 
We are the patients' backup plan for mail order and everything else:
Mail order late? Go to your local pharmacy. 
Mail order out of stock? Local pharmacy will help. 
Lost your medication? See the locals. 
Your normal pharmacy is closed on weekends? See the chains. 
Your pharmacy that delivers doesn't on holidays? Go to the neighbourhood folks. 
Prescriber won't call in a refill until you're seen in the office in 2 days? Yep, the pharmacy peeps, if they say "NO" it's their fault. 
If there was a problem, yo I'll solve it. check out the hook while DJ revolves it. 
CPP: NnnnnnnICE. And please don't do that again. 
CP: We are the backup bitch. The fallback crutch. The bailout. 
Prescriber forgot to refill your scripts? Expect the Pharmacy to help. 
Out of insulin? And it's the weekend? A Holiday weekend?? See the pharmacist. (But only in town.)
CPP: Is there a new name badge in it phor me? 
CP: Yes. I will be Case and you will be Time. 
CPP: Case and Time? 
CP: Whenever you need us, we will be there. Justin Case and Justin Time. At your service. 
CPP: We should get business cards.

Wednesday, October 7, 2020

Thanks, Dad

CP: Have you ever noticed the similarities between corporate and a really awful parent?
ME: The beatings will continue until morale improves?
MICE ELF: KMFDM, nice touch. 
CP: Yes, but I was also thinking more mental. 
MICE ELF: Mind games?
CP: More along the "you'll never be good enough" line. 
ME: Someone you keep trying to impress but who never loves you back?
MICE ELF: "Here daddy, I made you this drawing" only to be told it looks like a 3-year old drew it. . . then telling him you are 3 years old?
CP: That, but also grades. No matter what you bring home, he will never be impressed or happy. 
Child: Dad! Look! I got a B! And I thought I failed. 
DAD: Mmm. Why not an "A"?
Child: <next test> Dad! I did it! I got a 94% A!
DAD: Hmm. That's all? Why not a 100%?

CP: No matter what we do, it will never be good enough. 
ME: I gave 27 flu shots today!
MICE ELF: Why not 30?
ME: I diagnosed a woman over the phone as actively having a heart attack and saved her life. She couldn't stop thanking me (true story). 
MICE ELF: Harumph. But did you give her the PP-FLUSH. . . Prevnar/Pneumovax-Plus FLU-Shingrix triple?
CP: Difficult to do over the phone. . . 
MICE ELF: You should try harder. 
CP: Yep. Never enough. 
ME: You're so right. It's all about "why didn't you do better?".
MICE ELF: Or "what have you done for me lately to make me money?". 
CP: Yeah. We don't get paid to save lives or prevent deaths. Those don't impact the bottom line. 
ME: Must be why filling prescriptions is a distant 2nd right now to COVID tests and shoTS! shOTS! SHOTS!
CP: And you'll give 31 today yet be asked "why not 35? or 42?".
ME: Not even an "atta girl!" or "good job".
MICE ELF: Criticising and putting down those beneath you, it's on the test to become a corporate stooge.
CP: Like I said, Never enough. . .
All the shine of a thousand spotlights
All the stars we steal from the night sky
Will never be enough.

Phactory Of Phear

CP: I know it's early yet, but I was on hold with CVS and Walgreens last week. . .
Uber-Tech: Are you still on hold with them?
CP: Some days it feels that way. Anyway, it got me thinking.
UT: Well there isn't much else you can do while on those interminable holds.
CP: Be nice. It's not their phault the Powers-That-Be only give them enough staff to answer one call at a time.
UT: Right. Drop off, pick up, drive-thru, data entry, counting, 10 phone lines. . . itty bitty personnel scheduled.
CP: Sounds like Jafar's fate in Aladdin. 
UT: Sorry. As you were saying.
CP: As I was thinking, though you already did a good job making my point, I thought we could make a House of Horrors for Halloween.
UT: It's already scary enough here every day.
CP: True. We'd call it the Pharmacy Phactory of Phear. Lines of Q-Tips and Cue Balls snaking slowly through the queue, arms raised, moaning "flu shots. . . we want flu shots. . . HD flu shots. . . shaaaahhhhhhhhhtssss". 
UT: That is truly horrifying.
CP: Now imagine hearing nothing but the hold music for Walgreens and CVS. We could record the pharmacy staff trying to contact these pharmacies and screaming as they get phrustrated.
UT: Haunting, on all fronts. 
CP: That's the stuff of which nightmares are made.