When I'm out shopping, I'm drawn to other pharmacies like a moth to flame. I'll usually make a beeline to check out my colleagues during their workday, discreetly impersonating a shopper looking through the vitamins or family planning section while keeping the pharmacy under observation. Sometimes I'll pretend I'm on a supersecret spy mission of vital importance to the profession, which I realize may be a sign that I've been in the profession too long.
The last time I went undercover at my local chain drugstore, a simple sign in the patient-counseling area caught my eye. There, hanging right next to the pharmacist working diligently to keep up with the day's prescription load, was a simple set of instructions for the whole world to see.
"Keep your voice down," the sign said. My first thought was how awesome it must be to work in a place that encourages such good customer behavior. Then I realized that the sign mistakenly had been hung backwards; the side encouraging public quiet was actually intended to face the pharmacist while he was counseling.
Then I noticed that this sign seemed to be the only effort this chain had made toward HIPAA compliance. The pharmacy was completely open, in a layout very similar to that of my favorite sandwich shop. While pretending to shop for diabetic test strips, I stood less than 3 feet from the pharmacist and listened to him take 2 prescriptions over the phone. Every word.
The only thing that could have prevented my overhearing someone get an early refill OK for some Xanax from their doctor's office would have been if the pharmacist had used a telegraph. Even then, if I knew Morse code, I might have figured it out. I realized that the people behind the pharmacy counter had been issued orders by the corporate mothership, but from what I saw, they had been given absolutely no tools to carry them out.
Most of us practicing pharmacy at the turn of the 21st century face a Catch-22. We have lost control of our profession to the corporations that employ us, yet when it is to the advantage of those corporations, they still pretend that we are individual practitioners.
Who's held to account if a patient isn't counseled where you work? You.
Who hears from the boss if too many clocks on your computer screen turn from green to red before the prescriptions get out the door? You.
Whose license is on the line as you decide whether double-checking something you think might not be quite right is worth a red clock that goes down on your permanent record? Yours.
Yet are you given enough staff to counsel your patients on every new prescription? Figure a minute and a half to talk to each person times 500 prescriptions a day. In all my spying, I've never seen a pharmacy that was set up for a pharmacist to do 12 and a half hours' worth of counseling a day. Neither have I heard of one that was given more help when those clocks were added to a company's prescription-filling software.
All the responsibility, none of the control. That is the status of the modern pharmacist.
It doesn't have to be this way. Corporations can move very quickly when penalties are directed at them, as I learned when a former employer was taken to task for not crediting undispensed, partly filled prescriptions back to Medicaid when they were returned to stock. What was once impossible to do with our computer software was made easy, and every pharmacy employee throughout the organization was trained how to do those credits with a speed I had never before seen our company display.
The same thing would happen if state boards started citing employers whose working conditions make it impossible to counsel. Or if a class-action lawyer were to overhear his Viagra prescription being called in while he was shopping for diabetic supplies.
So while there's a chance that it might be me the next time you feel as if someone's staring at you from behind the condom rack, maybe you should hope it's someone from your local law firm instead. Because the day that the people who actually control our profession start to be held responsible for it will surely be a good one — and one that's long overdue.
I never thought I'd say this, but I just might welcome the lawyers.