Diary of a Neighborhood Pharmacist, Entry #11

The overwhelming majority of prescriptions are simply count and pour orders – read prescription, fill prescription – no thought required. Doing these the old-fashioned way takes about five minutes, seven if you're slow. Allowing for those prescriptions that actually require some discussion with the prescriber, a review of dosing, or a discussion with the patient, you might get an average time of 10 minutes each.

If the pharmacist is making $50/hour, the mark-up on each prescription has to be $8.33 for the pharmacist's salary alone, plus more for other expenses and profit. Since the insurance companies aren't willing to pay this much, the goal becomes to increase productivity – more technicians, more computers, more volume – so that the pharmacist's involvement with a prescription may drop to as little as one minute each. At the store I'm working at now, they have a PharmAssist machine. The prescription is entered into the computer, which signals another machine what drugs to count. It's all done with computers and bar code readers. It's a very sophisticated system.

Unfortunately, it doesn't work. It puts in lots of protections for the chain store, but it's bad on human factors. People will be very careful – once. But if there are too many checks, too many verification steps, then they get rushed through. The pace is too fast – like Charlie Chaplin in Modern Times or Lucille Ball in the candy factory. There's always reliance that, if something is wrong, somebody, or more often something else, will catch it.

And so, last night, while I was working with a young pharmacy student, an elderly couple came in to complain that they'd been given the wrong dosage. They were supposed to have received 50mg tablets, and got 100mg tablets instead. It was the type of thing that shouldn't have happened – the label clearly said that the order was for 50mg tablets – but the vial was filled with tablets that were clearly marked 100. Fortunately, the patients had recognized the error and returned, but unfortunately, when they got to the pharmacy, they spoke to the student first.

There is the story of the old farmer, who, when he first saw an elephant, said, "There ain't no such animal." The student looked at the tablets, saw that they were the wrong ones, but also knew that they had come from the dispensing machine, that marvel of modern accuracy. I could hear her saying, "It came from the machine," pausing, and then repeating, "It came from the machine."

It wasn't clear to me if the mantra meant "It's not my fault." (And frankly the first thing I did when I got to the vial was to check to see if the error happened on my watch). More likely, she was faced with a terrible conflict: There was clearly an error, but the machine doesn't make mistakes. The machine never makes mistakes. It can't be wrong – it came from the machine.

See the previous installment, Diary of a Neighborhood Pharmacist, Entry #10, or the next installment, Diary of a Neighborhood Pharmacist, Entry #12.

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