Tuesday, April 03, 2007

ABC News Exposes The Truth; If You Are Sick, The Safest Thing To Do Is Not Fill Your Prescription.

I was alerted to last Friday's 20/20 expose on the chain drug industry by your letters. More than one of you wrote in asking me to give my take on the piece. I'm humbled. You folks do realize I'm just some crank with a computer don't you?

I will also say I haven't seen the whole piece. The irony being that while it was airing, I was decompressing from the effects of a 12 hour day spent trying to keep up with a flood of your prescriptions. My comments here are based on a couple video clips someone was kind enough to send in:



My first thought was, who knew 20/20 was still on the air? I remember that thing as a 60 Minutes wannabe from when I was in grade school. Is Barbara Walters still alive?

My second thought was the journalism compared to those grade school days is much worse. I never thought I'd say it, but I have found the reason people who watch Fox News claim to be smarter than average. Hugh Downs is probably rolling in his grave if he's dead.

The piece seemed to pick on Walgreen's. Walgreen's gets picked on a lot, undoubtedly because they are the leader in the chain drug industry, but also because they suck. OK that wasn't fair. Not all Walgreen's suck, just the ones that are doing the amount of business that makes corporate happy while meeting their labor budget. If your local Walgreen's doesn't suck, trust me, there is someone in the district office on the manager's case as to why that is.

Also in fairness all the major chains aspire to suck, it's just that Walgreen's is much better at meeting it's goals. There are definitely, most certainly, stores in every major chain that are dangerously understaffed. I left my last job for precisely this reason. I have seen more than one pharmacy that I would NEVER let fill a prescription for my family unless I was the one who could fill it.

The problem, however, is not 17 year old drug clerks. Anyone who thinks you need six years of college to count to 30 and put some pills in a bottle can kiss my ass. Give me an adequate number of employees whose head is not up their ass, be they 17 or 60 years old, and I will have no problem getting your prescription safely to you. You see, the 17 year old does the count, pour, lick and stick stuff while I look over your records, make sure it's not going to kill you, check that the licking and sticking was done correctly, and make sure you realize the antibiotic suspension does not go directly into your child's ear even though you know that's where the infection is.

Key words in that paragraph: Give me an adequate number. Like I've said, I've seen more than one big corpo-pharmacy chain location that was dangerously understaffed.

So what's an average non-pharmacy schlep who just wants to have their prescription filled at a non-dangerously understaffed location to do? In a nutshell, look for the slowest pharmacy you can find. I don't mean the pharmacy that makes you wait 2 hours, I mean the pharmacy that does the fewest number of prescriptions. You may find it's one of the big chains, but I doubt it. Look in the yellow pages for a place where you say "I didn't realize there was a pharmacy there" If you didn't, most other people probably don't either, meaning a better chance of avoiding dangerously understaffed syndrome.

Try places where pharmacy isn't the main business. Grocery stores, mass merchants like Target, and warehouse clubs like Costco, chances are they are not as busy as your corpopharma-chain, and not under the same type of pressure to get your McPills out the door. Also take a look at your local independent drugstore. There are still some left, and the owner usually isn't dumb enough to staff his store at levels that would get him sued. Or you could come to me. Of course you don't know where I am. Oh well.

There also seems to be a big deal made about corpo-chains *gasp* TRICKING people into waiving their legal rights. Brother.

Yes, it is mandated that a pharmacy offer to counsel you on your prescription when you pick it up. This is the most insignificant legal right you have. Where I work you can walk to a point right in front of me, about three feet away, and fire off any question or comment that comes into your little head. Anyone who thinks this changes the slightest when you sign something will have their profile checked for early Vicodin refills. I will also point out that anything I say to you in a "counselling" session will be covered in the 3 pages of written information you'll walk away from the counter with. Bottom line, don't ever put something in your body unless you know why and how. If you don't, fucking ask me. I won't check to see if you "waived your rights" before I answer.

Having said all this, I do wonder in an age of war and climate change, just exactly why ABC feels the best use of it's resources is to plant secret cameras in a Walgreens.....

Is Barbara Walters still alive?


Mother Jones RN said...

Thanks for the advice on how to get your pills without getting killed. I guess there's an upside to having lousy health insurance coverage. I don't always fill my prescriptions because they aren't covered under my plan, or because the co-pays are too high.


Anonymous said...

This piece pissed me off. I'm glad you stated things out as straightly as you did. In WA state, the requirements for techs are 18 years of age and Board of Pharmacy approved training program. And yes, having a sufficient number of us around. I'm pretty good, I can do the work of 1 & 1/2 when I have to, but I certainly can't do the work of 2 or 3. All reasons why I left Walgreens...

Anonymous said...

BabaWawa is no longer alive, but she *is* still on TV!

I worry a lot less about the pill counters than I do the docs that push them. From the latest Harper's:

"Estimated number of Americans who die each year as a result of doctor's sloppy handwriting: 7,000"

Anonymous said...

Well said!

OR RPH said...

Did anyone notice the long Mcdonald's type line at the drive-thru???

I think many people (including the chain management) are getting a fast food mentality about pharmacy...it is very dangerous.

Where I used to work, I told people all the time "Don't go there unless I am working!!" I think many pharmacists feel this way..

You do a great service Drug Monkey...even if it is just for me to laugh out loud after a long day!

Megan said...

That piece was the biggest pile of BS I've ever seen. The whole bit about "Can I ring this up here?", the dude was picking up an rx for warfarin and trying to ring up Aspirin, expecting the clerk to catch the interaction. He didn't fucking say, "Can I take these together?", he asked if he could make a purchase at the pharmacy counter. Hell, I've converted stores that hired people solely for the purpose of running register. A monkey with half a brain does that job.

And "waiving your rights to pharmacist counsel"? You do have to sign that log to say that you picked it up, otherwise when you call me in a day and tell me that your Oxycontin was not in the bag with your 8 other controlled's, I can go back and look up your signature and prove to your lying ass that you did pick it up, look harder.
There are two parts to that log. 1) I am the person picking up this medication. 2) I do not have any questions for the pharmacist. Fucking people piss me off. Today we had a lady request to talk to the pharmacist about her medication. Why? "I want to make sure some 15 year old kid wasn't the one that checked my medicine!!"

Way to go, 20/20. Sinking to new depths of depravity of scare journalism. Fuck you.

Anonymous said...

See the full version here:

Part 1: http://www.youtube.com/watch?v=cT5GJL0tEto

Part 2:

Anonymous said...

Can you make a post with your top list of bands/songs?

vicodinfairy said...

The problem is, it's hard to find good people who will take the crap the general public shells out on a given day. I've had so many techs up and quit because they just can't deal with all the bullshit, the yelling, the name calling, the total ignorance of insurance benefits...and yes, the chronic shortage of pharmacists and other qualified employees. I'm at my wit's end myself! Also, FYI...if a store is slow you still may not be safe as that is where corporate pharmacies stick the dum-dum pharmacists. The ones with personality disorders or a bad case of book-smart-people-stupid.

If the person who invented drive through pharmacy isn't dead I want to kill him. With a spork. Slowly. Most assuredly the DUMBEST invention EVER. I HATE the drive through. The only reasons people use it is because they don't want to put out their cigarettes/get off the phone/get off their giant asses and walk 15 steps to the door.

I tried to come up with a skill I have that would permit me to quit pharmacy entirely...I came up blank as I am too old to try out for American Idol. Damn.

anon., CPhT. said...

"Serious deception?" They "never tell you" you're waiving your right to counseling? Bullshit, I get asked if I have any questions for the pharmacist each month--by techs who know I'm a tech and I've been taking the same drug for months.

Of course, this isn't in Walgreens...

Bottom line, don't ever put something in your body unless you know why and how.

You mistake Americans for people with common sense.

Anonymous said...

Amen and Amen!!! Not only to your blog but to the folks who are commenting!! I am a pharmacy clerk (bottom of the food chain but I like to think I do a really GOOD job)at one of Walgreen's competitors, one of those drugstores in a grocery store chains. I disagree with one point you made, sometimes the slowest pharmacies are slowest for a REASON!! We are one of the busiest pharmacy's in our town, we average 450 - 500 scripts on an average day. The reason we are so busy is that our pharmacists care about people, we are as honest and upfront with people as it is possible to be, our wait time is about 1/10th of Walgreens across the street (which starts at 2 hours and rapidly increases) and I like to believe that my smiling face across the counter has something to do with it!!

Kristen Ban said...

The problem with the McPill and McPharmacy mentality is NOT just the corporations.. for some reason people have no problem waiting in their MD's office for FOUR HOURS but TWENTY MINUTES for FIVE PRESCRIPTIONS... WHAT?! You, the consumers, are rushing us through our jobs. In my store, we do the same number of Rx's in a day whether the wait is 20 mintues or two hours.. doesn't it reassure to know we will spend TWO HOURS making sure your Rx is correct?? I started as a tech a16 - and I knew nothing.. but I knew how to match DINS and I knew how to place the RX in front of the pharmacist so my work was checked! I prefer the techs who know nothing, now, as a pharmacy student, becuase this ensures all inquiries and problems are directed to the pharmacist - me with 7 years of university, rather than trying to handle it themnselves. I'm from Canada, and we've had people come in and question us based on this stupid stupid piece.. and still want their RX in five minutes.. to them: BITE ME!

FDPharmD said...

I have to say something about the coumadin lady on this piece.

Okay, so the med got filled with 10mg instead of 1mg. She was on 1mg to get some anticoag in her because of her tumor. She probably only had an INR goal of 1.5-2.5. I have some experience in a coumadin clinic so a lot of people did not do their job.

#1 if you are on coumadin you should be well educated on signs and symptoms of both clots and hemmorage, vitamin K intake, drug interactions, AND of course always know what dose you are on and what color it is supposed to be (so even if you cannot remember the dose you can tell me you take the purple, yellow, orange, green etc pill and I will be able to figure it out!). So she was not educated by the doctor, coumadin clinic nurse/pharmacist, or pharmacist at the pharmacy.

#2. How long was she on this dose. A good physician would have had her INR checked in 4 to 5 days to see how she was doing. Perhaps she was a slow metabolizer, we know they are out there and barely take any coumadin to move their INR. If she was a normal metabolizer and just starting on coumadin, even at 10mg per day I could not expect her to be any more over 5 or 6. Granted she could hemmorage at that level, but I have seen some stupid patients who drink a 6 pack of beer the night before and come in with an INR of 12! So what was her INR when she had the brain hemmorage, when was her last INR!?!?

Did she miss her appointment? Could some blame also be hers?

C'mon it is not like you take 1 dose of coumadin and boom you are bleeding all over the place, it takes up to 2 weeks to deplete the supply of clotting factors that have already been made.

Granted I know doc prescribed the right dose, she apparently was not educated, and it was not filled correctly, but a lot of things had to happen for this to not get caught, she was neglected with counseling and monitoring.

My request to patients is to know your medications, and if something changes, ASK, DO NOT ASSUME.

dom said...

Great work! My pharmacy classmates love some of your posts. Your comments and attitude towards some pharmacy issues sound very similar to mine, but worse! Again, great work.

Megan said...

Re: "Okay, so the med got filled with 10mg instead of 1mg. She was on 1mg to get some anticoag in her because of her tumor. She probably only had an INR goal of 1.5-2.5. I have some experience in a coumadin clinic so a lot of people did not do their job."

My question is, on that high a dose of Coumadin, how the bloody hell did she have a STROKE?

Anonymous said...

About coumadin....after major surgery a Home Health nurse came twice weekly to monitor my taking the med, she got a pinprick of my blood which she checked against something in her bag. After three days she told me to double the dose. After another three days she said to triple it, but then there would be only enough pills for two days, so I called in to the pharmacist to get it refilled. Very quickly the surgeon's office called me and left a phone message -- 'Stop the coumadin altogether'. I did immediately and the nurse never explained a thing. Didn't ask her or the surgeon. Never occurred to me. Should have asked the pharmacist.

A few decades ago my pharmacy was in a Payless Drug. That pharmacist was the greatest guy. He wasn't a conversationalist, but you got straight info in concise words, and he was absolutely available to answer any question. Haven't used any meds since then til the surgery. Got the pain med prescription after surgery filled at Walgreens. Those people were rushing around so, I wondered if they could possibly have time to answer questions.

I was given no warnings at the hospital or the pharmacy about possible side-effects of the pain meds. The first I've ever taken in a very long life. But when I began experiencing those side-effects I went on line to research the drugs and to find out why, then weaned myself right off them.

Because of the Payless Drug pharmacist, I've always had the greatest respect and appreciation for pharmacists.

Anonymous said...

The 1 mg dose she was taking was to prevent catheter related clotting (CRC) because she likely had a port-o-cath to make chemotherapy administration easier. Prior to about a year ago, warfarin 1 mg PO daily was standard practice for CRC (it's not anymore). There is no target INR. Therefore, the MD was not following INR levels.

Anonymous said...

Very well written as always...I've been reading your blog for quite some time but I've never made any comments...call me the blogger-enthusiast virgin I suppose. I'm just going to say that I am glad I didn't see the report...I didn't even know it was on until the day after when we got the corpo "how-to-handle-the-fallout" email. Being a current pharmacy student I don't get around to watching TV much...or out much, getting...pale...so...pale. I intern at a Walgreens and I think it is a shame that they were singled out...as you mentioned not all Walgreens are horrible, and I am fortunate enough to work at one that is very well respected in our part of town due to a couple extraordinary pharmacists with the patience and bed-side manner of Job, and of course great techs that still can teach me a thing or two! Really, I think the quality of a pharmacy comes down to the people that work there, and only partially how understaffed they are. Our pharmacy has increased filled scripts by about 100/day over the last year without an increase in staff, yet our propensity to make mistakes has not gone up. Our wait times have gone up, much to the dismay of the Vic addicts that have been sitting on their Rx for a month, but somehow needs it "NOW", and of course the "but I've been out for three days, what do you mean I have no refills?" crowd. We'll see...I'm not quite yet entirely jaded about the retail pharmacy business. I am however jaded about people and their general non-interest in self care...does anyone else feel that the atmosphere of health care gives the impression that there is a pill to fix all ills and to hell with PREVENTING chronic disease? Example--20 year old male with a extensive family history of diabetes/HTN/MI being sedentary/obese and living on McDonald's, HoHos, and soda. I don't even have a family history of DM and I avoid processed, refined foods like the plague.

OK so I guess working retail and being exposed to the general Medicaid population for almost two years and given me the urge to smack the hell out of most people and institute mandatory sterilization...

As far as the business model of healthcare goes, retail pharmacy should be the least of everyone's worries. Retail's drive to make a buck pales in comparison to insurance and big pharma. I left a medicinal chemistry PhD program because I was disgusted with the emerging attitudes in drug discovery and design. We were flat out taught that research in chronic disease (ie HIV, cancer, DM) was pushing towards "management" because it simply made a larger long-term profit than finding a cure. That is more unsettling than anything "20/20" could have to say about Corpo pharmacy chains.

Anonymous said...

I love reading your blog!!
I agree with the fast food mentality mentioned above. That is why my pharmacist friends and I started www.fastfoodpharmacy.blogspot.com.
Check us out!
And another thing-FUCK YOU 20/20!! Why don't you try working behind the counter? It sucks!

Anonymous said...

For Megan: Strokes can be embolic or hemorraghic. Go back to studying.

Megan said...

Sorry, I'm not actually on the career path to inhabit my 9-5 hell permanently. Thanks for the explanation though, and the snark.

Mc RPh said...

If 20/20 were really concerned about pharmacy errors, they could have spent about 60 seconds explaining to potential pharmacy customers how dangerous it is to just walk up to the pharmacist and demand their attention.

See the phone I'm on? See the computer I'm staring at? I'm not interested in ringing up your toothpaste or arguing whether or not something is 2 for $5.

Every time you demand my attention, you are distracting me from DUR's, verifying accuracy of rx's and policing narcotic addicts trying to get fakes filled at the expense of my license.

PS.. McDruggie's had the great foresight to hire cashiers up at the front of the store. Their entire reason for working there is to ring up your merchandise. Unless you are planning on staying in my store forever, you'll eventually be going in that direction anyway. Bye.

Anonymous said...

I just finished watching the 20/20 episode on YouTube and I'm livid. I'm a certified tech and I've been working in a pharmacy for almost 3 years. It amazes me how the could blame the technician on the overdoses. Regardless of whether or not she typed in the Rx, it IS the pharmacist's job to be sure it's 100% correct. It's not just the pharmacists who are getting overworked, as I'm sure everyone here knows. I have worked MANY MANY 80 hour work weeks and most of the time off the clock because the company doesnt want us to have overtime so we break their budget. They took hours from us and we were struggling badly...and now our Rx count has gone up by over 150 scripts a day and they are trying to take MORE from us.
I love my job because I get to help people, but big corpo really needs to start fucking helping us, especially since we're the ones fielding the questions and accusations about that damn TV show. It's bullshit.
And the whole "waiving your right for counseling??"...OMG. I almost threw something. That's why when they ask you "Do you have any questions for the pharmacist about your medication??" you're supposed to say "yes"

Anonymous said...

Yes-what an amazing concept-pharmacists actually make mistakes. Has anyone at 20/20 ever looked at the ratio of correctly filled prescriptions to those incorrectly filled? Yes chains are often woefully understaffed, which puts a huge burden on said staff. Try providing cognitive services in addition to filling, checking and resovling billing problems and then trying to make sure the patient at the drive in window is taken care of. These so called invstigative reports might be better served by finding out the cause of the "problem" instead of just causing panic and distrust of pharmacists. The systems wants and demands extensive patient services but PBMs barely pay for the pills and a bottle. How does any chain or independent provide the services wanted when reimbursement is cost and from $0.00 to $2.50 as a dispensing fee? They seem to forget TANSTAAFL!

To the overworked tech said...

Don't let yourself be abused. Stand & speak up! Why would you want to work off the clock? I work for Walgreens, and we are never allowed to work off the clock, we just accumulate overtime. If you 'help them' off the clock on the limited budget, the manager will never know that they need to hire more schedule and help them.
Just say 'no' to working overtime off the clock, and go home in the middle of a chaos. What are they going to do? Fire you? If they are that busy, they dearly need you, and you did nothing wrong legally.

Major_Tom said...

"Hugh Downs is probably rolling in his grave if he's dead."

Hee hee...

Actually, I just saw him in an infomercial for an odious piece of crap called "The World's Greatest Treasury of Health Secrets". Which, for all practical purposes, is probably the same as being dead anyway. Given the parlous state of American journalism, it's difficult to blame him.