Tuesday, April 20, 2010

Out Of The Mouths Of Babes.....

One of the things I miss about the Midwest are the thunderstorms of summer. How just when the oppressive heat and humidity of a July afternoon seemed to be about ready to make you crack, you would hear it, that soft rumble on the horizon. When I lived in the flat part of corn country you could see it as well, towering thunderheads off in the distance with sparks of lightning jumping from cloud to cloud and cloud to ground. It was beautiful. When you heard that rumble though, you best not stop and admire the beauty for too long. Because those thunderclouds were coming at you, and soon all hell would be breaking loose. Rain and wind and ear-piercing thunder and sometimes even a little hail and a funnel cloud or two would be all around. Lightning strikes. Scary stuff. You would have no excuses to get caught in it though. You were warned. You totally saw if coming if you made even the slightest effort to open your eyes.

Today I heard a rumbling of thunder far off in the horizon. A storm is brewing in our profession.

I'm talking about a post over at Jim Plagakis' forum by a pharmacy student named Davey. Davey had the pleasure recently of attending California Legislative Day held at the Sacramento Convention Center. Most of you know how these things go. For those of you that don't, I'll let Davey set the stage:

There is always a sense that these organizations beef up their meetings by inviting a ton of students who have no idea what's going on or why they are there. I looked around me and saw my student colleagues talking to each other, on their cell phones texting, or just flat out not paying attention to the speeches. Some were studying their class notes since they were missing their Wednesday classes.
...Questions came from industry leaders, members of the CPhA Executive staff and foundation, and other non-descript people in suits who asked obvious, unchallenging, and most likely staged questions. Not one student made a peep.

Yup. That's the general gist of these circle-jerk sessions. Suits masturbating each other with students in white coats in the background to show just how happy the future of pharmacy will be. Meanwhile various graphs and icons and little clocks on chain pharmacy computers all across the state were turning from green to red to let pharmacists know they weren't moving the prescriptions along nearly fast enough.

What surprised me most about Davey's post was how much the man taking the questions, California Assembly speaker John Pérez, seemed to have a grasp of the problems of our profession during his speech. What delighted me though, was what Davey decided to do:

Meanwhile, from my seat, my heart raced. I realized I had a chance to do something here. To stir shit up. I like to stir shit up. I looked around me at the stoic faces of students, some stuffing the house tiramisu into their faces, then I looked at a piece of paper I had scribbled the beginnings of a question to Mr. Pérez on. After responding to the second or third time a reimbursement question came up, he announced he was taking one more question, and suddenly, I was having an out of body experience. I watched myself literally push my seat out from under me, and stand on my own two feet and bear towards the back of the convention center where the mic was in the hands of another industry leader asking an obsequious question. I quietly asked the mediator of the mic, a CPhA employee, if a student could ask a question. He showed hesitation, but after the pharmacist with the floor was finished, the CPhA employee asked for one more question of Mr. Pérez, and it was allowed.
Cue the nerves. Tachycardia, positive inotropy, body and brain in overdrive. I looked back at the area of the room where all my classmates were sitting. One of them had a worried, quizzical look on his face as he looked me in the eye from 45 feet away. Some others were whispering discretely to each other, glancing periodically at me. I wasn't thinking---only doing, an adrenaline storm giving me some involuntary control over my brain to dare to do something completely taboo in a setting like this.
It was my turn. I took the mic and thanked Mr. Pérez for the opportunity to ask a question. I was incredibly nervous. Having no lab coat on, I identified myself as a second year pharmacy student. I heard the echo of my voice in the mic, but proceeded to ask the assemblyman in so many words:
"How do we as pharmacists expect to push for these new legislative measures (adding immunizing to a pharmacist's workload without extra staffing), when, in your experience as a protectorate of laborers, and knowing that pharmacy is primarily run on a for-profit model, you've just addressed that this is likely to increase medication errors not reduce them because it just adds to the pharmacist workload without the pharmacist getting that added coverage it needs from its employer. Do we ask you, assemblyman, for this right, or do we ask our employer? Thank you."
The assemblyman addressed my question after intermittent nods during my 45 seconds of speaking. Time stood still. A few tables away from where I was standing, which was in the very back of the room, I saw my District Manager.

Out. Fucking. Standing. Let me tell you something Davey. The next time you ask that question to someone in power, you will not be nearly as nervous. And somewhere down the road, one of those students who spent the day texting on their cell phone will repeat that question, or one very much like it, to someone above them, their inhibitions lowered because they saw you do it already. At some point, the tenth or twentieth time you ask that question, you will be tired of it not being answered, and you will not let the person you asked it to off the hook until they do.

And others will not be letting the person they asked their questions to off the hook until they do. And those people in power will have to do something. Because rain and wind and thunder will be all around them.

And if those people in power make the slightest effort to open their eyes, they see it coming. They probably won't for awhile though.

Keep asking.

6 comments:

The crew of Lucidity said...

Right on Davey!

CodeRx said...

From one pharmacy student to another, way to go! Our generation needs more people like yourself!

Anonymous said...

This is good! He did great. I went to a weekend CE meeting a couple months ago and there was a "round table discussion" on accuracy and errors. It was filled with a bunch corporate hacks and board of pharmacy people and only one guy that actually works in the trenches. A few guys in the audience stood up and had some words with the board member about staffing. The problem with the board in my state is that it is filled with corporate DM types protecting their asses and teachers from the universities that want to mold pharmacy in some unrealistic image. What a load of shit. This kid is right, the more people stand up and the more people speak out, the more chance that critical mass will be met. Keep up the good work.

Tyler said...

They keep cutting our hours at work, even though our numbers have gone up. This time, not just tech hours, but pharmacist hours too. Not sure what the hell is up, but pretty sure our chances of errors is about to go way up and our quality of life at work is going to go down

Anonymous said...

I literally have no times to give pharmaceutical counseling to all new prescriptions and new and refills prescriptions of medicaid/medicare D/ federally insured patients which are required by state of Minnesota and counseling.

I am going along with company on Immunization certification program though since if you don't you may be targeted for transfer where the Minute clinic is not on site.

Why is the Board of Pharmacy and National organization doesn't speak for prescriptions ratio
to pharmacist and technician ratio so pharmacist can provide counseling and show and tell final check?

This is not only reduces the med error but promotes public education and adherence and patient's health and safety but also saves overall health care costs!

No one can't be on two places at one time, and this will also affect customer service.

Keith said...

Davey stood up for all of us! He asked the crucial question. It is a question we should be thinking and talking about: where is a profitable pharmacy model? The world runs on profits...on profits from providing goods and services. At one time, pharmacy provided goods for a profit. Today, pharmacy mostly provides a service. But, someone else, some third party determines our reimbursement. We have no control over our profit or even if there is a profit. So, we are left to scratch our heads and try to find a profitable place for pharmacy. Those folks that dreamed of third parties paying pharmacists for counseling and clinic services need to rethink their model. Looks like it may be a failed model.