Diary of a Neighborhood Pharmacist, Entry #24

In a recent column in The New York Times, Jane Brody basically said that in order to prevent medication errors, patients should ask questions if the drugs don't look right. She's completely correct, but we, meaning the retail pharmacy industry and the insurance carriers, seem to think that errors are a sort of collateral damage, and patients should just trust us. The problem is the usual: In order to keep costs down, there is a pressure to keep productivity up, which means speeding up the assembly line, à la Chaplin in Modern Times, or Lucille Ball on I Love Lucy.

We have insurance companies that try to funnel maintenance drugs to mail order – you can get a 90-day supply of medication by mail order, but only a 30-day supply if you go in person. Of course, if there was a dispensing error, whom are you going to ask? The postal carrier? Then, I once worked (for one day) at a very nice neighborhood pharmacy where they had no compunction about filling prescriptions with drugs from different manufacturers. That is, if they had a script for 21 tetracycline capsules, they didn't mind using 10 from Teva, and 11 from Ranbaxy, or some such combination. So, a vial might have some red capsules and some blue capsules, and the patients learned to take this type of thing on faith and not ask questions.

Many years ago, I was working at a store, and a patient, an elderly man as I recall, asked me how to take his medication. The prescription just said "as directed" – and, as best I can recall, it was one of those drugs that could be taken in different ways, either once a day or in divided doses. "Didn't your physician tell you how to take this drug?" I asked. The patient said no. "You really should call and ask him," I said. The patient looked at me and said, "I can't do that. He's such a busy man." At the time, I was offended by the idea that a physician would be too busy to answer a basic question – but now that's trickled down, and there are times when we get too busy to talk. (I used "we" instead of "I" because, in my fat cat older years, I can refuse to work in that sort of environment. Not many people have that kind of luxury.)

Jane Brody is right, of course – but we have to keep costs down, and insurance company profits come first.

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