Tuesday, September 4, 2007

A Tale of Two Transfers

Today, I had to call on 2 transfers from two different pharmacies within the same chain (CVS).

First Call:

Me: "Hi, this is Pharmacy Mike calling from busy chain pharmacy for a transfer. The RX number is 123456."

Pharmacist: "For John Doe? Atenolol 5omg. #30. 1 tab daily. 2 refills remaining. Original date 2/11/07. Last filled 8/2/07. Dr. Bob Kelso. Are your initials PM?"

Me: "Yes, and you're initials?"

Pharmacist: "MR"

Me: "That's all I need. Thanks."

Total call time spent talking to the pharmacist was less than a minute. Short, easy. Exactly the way it should be.

Now, let us contrast this with the second call for a transfer:

Me: "Hi, this is Pharmacy Mike calling from busy chain pharmacy looking for a transfer. I don't have the RX number, but the patient's name is Jane Doe, and she's looking for her birth control."

Pharmacist: "OK... hold on." (3 minutes go by, and I hear is rapid typing in the background)

Me: "Hello? You still there?"

Pharmacist: "Hello?"

Me: "Did you find the patient in the computer?"

Pharmacist: "Yes, it has 2 refills left."

Me: "What has 2 refills left?"

Pharmacist: "The prescription has 2 refills left."

Me: "I don't know what the prescription is. The patient just asked for her birth control transferred. I dont' know which birth control she takes."

Pharmacist: "Ortho tricyclen... hold on..... .. . . . . . .. . . .................... It's ortho tricyclen. 3 packs at a time, with 6 refills on it."

Me: (thinking we're finally getting somewhere) "What's the doctor's name, original date, and date of last fill?"

Pharmacist: "Dr. John Dorian. Original Date 4/1/07. Last filled 8/1/07. "

Me: "Wait, are they too early? Did they get 3 packs on 8/1/07?"

Pharmacist: "No... 1 pack at a time"

Me: "So wait... are there 6 packs left on the script or 6 refills on the 3 packs?"

Pharmacist: (Long pause) "6 refills, so this time with 480 tablets remaining."

Me: "So where the hell did you get the 2 from initially? .... Nevermind... so, it's basically PRN refills?"

Pharmacist: "Yes"

Me: Alright... (I got initials and finally hung up).

OK... now I know that I made things a little more difficult the second time by not having the prescription number. However, this should add 20 seconds to the conversation at the absolute most. All they have to do is search for the patient by name and then check the profile for her birth control. It isn't all that complicated!

The thing I just don't get about it is that the two different pharmacists both worked for CVS, so it's not like you can blame the software for making it complicated. There's no other explanation other than the second pharmacist was an absolute moron. Seriously, what is so fucking hard about reading the information off a computer screen??? Moreover, how in holy hell did he go from telling me there were 2 refills originally to having it be 6 refills (1+5 for a whopping 480 tablets left on the script after we fill it)? Did he not even look at the profile at first? And if that was the case, then why the fuck did it take him 5 minutes just to take a wild guess at how many refills were left?

I guess the most plausible explanation for this is that the guy was one of those pharmacists who float from store to store and do nothing but check scripts all day. He probably had no idea how to use the software, so it took him 5 minutes just figuring out how to bring up a patient by name.

By the way... Yes, it's true people... If you're pharmacy is one of those big chains like CVS or Walgreens, you've probably had a prescription filled by a pharmacist that barely knows what he's doing. Walgreens and CVS open up so many stores so quickly that they don't have enough pharmacists to adequately staff them. Therefore, they have to borrow pharmacists from temp agencies or employ a ton of newly hired floaters that have yet to be properly trained. Since the technicians at Walgreens and CVS generally have superior training to other pharmacies, the pharmacy can get away with the pharmacist having nothing but the most basic knowledge of the software and general store operations. As long as they can read a pharmacy label and compare it to a prescription, they're good enough to fill 400-500 scripts per day without another pharmacist.

It's scary for customers, and it's freaking infuriating for pharmacists to try to pry any information from them. I forgot to mention that a lot of time, they don't speak English well.

Oh... the joys of this profession.


Anonymous said...

As someone who used to work for one of those "big chains" I can tell you that it's not that the pharmacists are "absolute morons". Pharmacists can be absolute morons no matter where they work. It's not a lack of understanding of the computer system either. It's having to deal with understaffed pharmacies where you are being pulled in umpteen different directions at once. All the training in the world won't help when your working on your third 14 hour shift in a row and you really can't remember when the last time you defecated was, not to mention when anything resembling nutrition got into your blood.

Don't get me wrong, I left the big McPharmacy for many reasons, one of which was unrealistic demands on a health care professional. I was there for over 10 years and at one point was responsible for training new pharmacist hires on our system, so, yea, I knew the system...but yea, I've also had days like you describe.

I also think you do a great disservice to the profession by saying that your pharmacist "barely knows what he's doing". Yes, it's true that a majority of the job is simply checking prescriptions, and yes, I've had days where I felt like a robot...but I also know that I've been there to answer questions, resolve DURs, deal with physicians etc...just because someone is overwhelmed with work, hungary, and full of urine does not mean they don't know what they are doing.

Pharmacy Mike said...

I work for a busy chain pharmacy also. I know what it's like (probably more so than most) to work with an undertrained staff. I know what it means to get pulled in 10 different directions at once so that you're basically doing nothing but spinning around in circles without getting anything accomplished.

Being very busy and stressed is a perfectly legitimate reason to take 10 minutes to answer the phone when I call for a transfer. I expect to be put on hold and to wait quite a while for the pharmacist. However, once I get a pharmacist on the line, a transfer should be really quick.

I don't care how busy a pharmacy is. When I give another pharmacist the patient's name, it shouldn't take them 3 minutes (in which there is absolutely no communication with me at all) to look her up.

Furthermore, I did not say that ALL pharmacists don't know what they're doing. Indeed, most are very very competent. However, there is no denying that there a few pharmacists out there (especially in the ranks of Walgreens and CVS) that are put in busy situations before they have adequate training.

My pointing out the truth about the way the big chains staff there pharmacies is not a disservice to the profession. Those "McPharmacies" are the ones doing the disservice by building too many pharmacies to adequately staff and expecting newly licensed or newly hired pharmacists to handle up to 500 scripts per day without another pharmacist.

The only way to help the profession is for our customers to understand just how shitty our work conditions can be and realize that these high workloads put them at risk. There is something definitely wrong with the way the big chain stores view the "profession" of pharmacy. And in the extremely unlikely event that my posts sway some people to avoid these chains and fill their scripts elsewhere, then I feel I've done a good thing.