Friday, July 30, 2010

Let's Stop Pretending There's Privacy in Retail Pharmacy

HIPAA, HIPAA, HIPAA, HIPAA... Everyone's pharmacy employer pounds those 5 letters into us all the time. We're all concerned with privacy. Every time there's a privacy leak in a health care facility (be it a hospital, pharmacy, whatever), we all go ape shit about it. "How could this happen?" "Why aren't they more careful?"

I'm going to let you in on something that's not really a secret: THERE IS NO PRIVACY IN RETAIL PHARMACY. Now, that that's out of the way, we can all stop pretending and get back to doing our jobs.

See, the problem is that people are only selectively concerned about privacy. For example, many times some customer will get all belligerent because we'll ask for his address when picking up a prescription. "I don't want to shout out to the world where I live!!" (Of course, he has no problem loudly broadcasting how much of an asshole he is). Not to stereotype, but there seem to be more women worried about this one than men. It seems the skittish ones are always worried about someone following them home and raping them or something. Who knows? Who cares?

The big one is that we can't say the name of the medications our customers are picking up. It's a HUGE no-no to tell the world that John Smith is picking up Viagra or that wholesome looking Jane Doe is getting Valtrex for the raging case of Herpes she picked up from one of her wild weekends. I completely understand the desire to keep information like this private. Some of this is embarrassing shit. Therefore, it makes sense that a person might be a little peeved if some of this information was intentionally or unintentionally made public.

However, people only seem to be worried about privacy when it conveniences them. They really don't want complete privacy at all times, just when privacy doesn't get in their way.

Want proof? Here's a very simple way to illustrate what I mean. Go get your phone, and call your pharmacy. Make sure to speak to a pharmacist because all calls regarding this kind of sensitive material should be handled by a highly trained professional. Once you have the pharmacist on the phone, ask if there are any prescriptions filled for yourself. Ask for the name of the medication, what it's used for, and the price. I guarantee you that the pharmacist answers all your questions in his most customer-friendly tone of voice.

Now, if you're being consistent about this whole privacy thing, you should stop the pharmacist mid sentence as he's explaining your medication to you, and loudly proclaim, "YOU'RE VIOLATING MY PRIVACY!!!!"

I work in a pharmacy that fills a little less than 2,000 scripts per week. We have a lot of customers. I can match a face to a name of maybe 15% of our customers. Out of that 15%, there are only a handful of them that I'm so familiar with that I can recognize their voices over the phone. Therefore, any time I give out any information over the phone to anyone whose voice I don't recognize, I'm violating HIPAA.

95% of the time I don't have the slightest idea who I'm talking to over the phone. Someone calls and asks a question. I answer it. Someone calls and wants to know if a prescription has been called in for so-and-so. I tell them. I'll even tell them what it is and what it's for. I'm sure this is true of any pharmacy.

Have you ever tried to tell someone you can't give out information over the phone? The person gets all pissy. They don't care about the privacy laws in that instance. They only care about privacy when being private doesn't stand in the way of getting information they want at a time that conveniences them.

Here's another question: What percentage of prescriptions are actually picked up by the person for whom the prescription is filled? 30-40%? Maybe? It's almost comical. Seriously, try to keep track of who picks up for who one day. Most of the time, the person picking up is the mother, father, husband, wife, girlfriend, boyfriend, son, daughter, relative, friend, etc. of the person for whom the prescription is filled. We have no clue who any of these people are. If Jane Doe comes to pick up Jane Smith's prescription, most of the time, unless told otherwise, we'll just assume that Jane Doe is Jane Smith. We'll even offer to counsel Jane Doe on Jane Smith's medications!!! What kind of privacy is that???

In most cases, anyone can walk up to any pharmacy and pick up anyone's prescription. We don't ask every customer for ID. Hell, we hardly ask anyone for ID. Just about the only time anyone whips out an ID at our pharmacy counter is when they're buying pseudoephedrine products. There's more discretion in buying fucking Sudafed than there is picking up a medication for someone. Once again... How is this privacy?

You know what though? We want it this way. How fucking inconvenient would it be to have to show an ID for every pharmacy transaction? It would be incredibly frustrating to have to cut through miles and miles of privacy red tape just to find out over the phone the copay on your prescription. Let's all face it: We don't really want true privacy at the pharmacy. We just want the illusion of privacy. We want there to be just enough privacy protocol and procedures followed to demonstrate to us that the pharmacy at least cares enough not to blurt out your medical history to the entire store. It makes us feel comfortable and maybe helps us sleep at night.

It's all just an illusion though. Therefore, let's stop with the HIPAA pretenses and get rid of all that stupid red tape so that we might be able to more easily do our jobs.


Anonymous said...

I thought the whole HIPAA thing started out with the illusion that health insurers wouldn't be able to 'buy' gobs of individual private patient information to deny patients from being able to get insured. That idea flew out the window as soon as those applying for health insurance were threatened with lawsuit if they didn't fill out the form truthfully.

I absolutely hate it when the first thing that comes out of the receptionist's mouth when I call to make an appointment or the clinic or hospital refuses to tell me anything about my ill 18-yr old 'because of HIPAA'.

As a pharmacist, I also hate it when some office person at el corpo pharmacy benefits organization refuses to connect me to a pharmacist when I want to find out pharmacy information about the patient, refuses to help transfer a prescription, or even confirm that my patient's received prescriptions at their drug clearinghouse.

Anonymous said...

I agree with you about the people picking up prescriptions. It is almost never the patient. And we always at least offer to counsel that person about someone else's meds. However, when some one calls in to see if their prescription is ready, I will answer yes or no and give them the co-pay or price, but I will not tell them what drug it is. I will ask them what they are expecting and I will confirm or deny only. Of course, they do get all upset about that. I will also not give the annual prescription summaries to husbands for wife or vice versa without a signed release. It may be inconsistent, but at least they is some limit to how much privacy you will violate.

Anonymous said...

I wonder how much fraud there is with people picking up other people's medications, and not giving it to the actual patient who needs it. Since IDs aren't checked, what's to stop someone from picking up a total stranger's medication and using it for themselves?

Anonymous said...

Hm, when I was an intern and ran register, I asked for ID from anyone picking up controls, esp C-2s. People did get really pissy with me.
As for over the phone counseling, key is, if the person never says a name--tell them whatever they ask.