Persnickety

In the olden days if a Mafioso ratted on somebody he'd get thrown off a bridge or tossed off a rowboat wearing cement shoes. Nowadays nobody's ratting on nobody. And why's that? Because the new mafia has made it darn near impossible to rat anybody out, just because it's all so stinking complicated that hardly anybody knows what's really going on. But the end game is still the same: kill any bugger that gets in your way or costs you money. When somebody gets killed every half hour in this country you'd think it might just get noticed. Nah. First you'd have to know the links, how it all fits together. And with a body on the floor who's going to notice the dozen different things that caused it to happen in the first place? Nobody, that's who. Here, I'll give you an example. Say Johnny Walnuts starts to notice his crew isn't taking in nearly as much as it did last year. So he ups his premiums, say. Things start to look better, but not as much as ...

If the pharmacy industry can finally solve the riddle of how to serve a patient's need for personal consultation (now vastly underserved) while demanding more and more of the pharmacist's time, then we will enter the next stage of medication management. As I wrote earlier, robot dispensing of medications holds great promise to free up the pharmacist to actually do what he/she is trained for: medication management (known in the biz as MTM, short for Medication Therapy Management ), inoculations, and training patients to better manage their disease states. It is amazing that students spend six years in training for disease and medication management but when introduced to the business world none of what the newly graduated can offer is actually used. Can pharmacists reduce the costs of health care by catching provider errors? Yes. Can pharmacists reduce hospitalizations, and emergency room use through Medication Therapy Management, increasing adherence to medication use? Yes, agai...

I've been wondering lately if retail pharmacy is dead or at least ready for some major triage. It's not that the local pharmacy is going to go the way of the dinosaur. Pharmacies will never disappear. But I do think they are going to evolve into a different "animal" than what we see on the corner now. I say that because of the different circumstances faced by the retail druggist than existed even just five years ago. In January of 2006 millions of elderly Americans began prescription coverage with Medicare Part D. This was not only a boon for seniors; it brought increased foot traffic into drug stores. The volume of prescriptions filled sky-rocketed. Then a couple of years later Wal*Mart brought its own brand of insurance reform by instituting their list of $4 medications. In an industry not known for creativity this was an earthquake high on the Richter scale of business practices. It brought price point back to prescription drugs, competition where none had existed ...

When did a pharmacy become a part of the fast-food nation? You walk into a pharmacy with your prescription in hand, present it to the technician or pharmacist, and start to walk away, confident that in a few minutes you will have your medicine and begin your life anew. When did that happen? I started in this business in 1983. At that time I remember this same expectation of quick, efficient dispensing, though I also remember that a busy pharmacy back then did about 100 prescriptions a day. We were still typing labels, though a few envelope-stretching chains and independents did have computers. So if we did ten Rx's an hour that was a busy. That works out to be one Rx every 6 minutes. Nowadays we do one Rx every minute or two. (That doesn't mean you get your prescription in two minutes; it's more likely to be an hour as the volume has sky-rocketed.) But back in the Jurassic period of pharmacy, independents used to fill prescriptions in a back room, beyond the view of custome...

  Since everyone else and their pet dog gets to sound off on what is the best plan to overhaul the United States healthcare system, I thought I'd put forth a few of my own. (Note: anyone who has been following this blog knows my reasons for advocating a single-payer system, so the following remarks are meant to be as an alternate to that most desired of solutions.) Lacking any real reform, which indeed seems now to be the resultant predicament we find ourselves in, we could save millions just by having one uniform billing form, and one uniform insurance card. I have seen insurance cards without any ID number, group number, processor number, or even a logo to let us know whom to bill. Honest. Give pharmacists the power of therapeutic substitution. If your insurance wants you on Prilosec OTC instead of Aciphex I could switch you to that drug without having to fax or call the office and wait the three days to hear back from them. They're only going to say switch it anyway. Advocat...

or not to err, that is the question. Lately I've noticed interesting reactions from patients when something unusual is noticed with their prescription. Let's say someone receives a prescription for a quantity that they did not expect. Joe Schmoe gets some Zantac 150mg, and takes it twice a day. He looks at the bottle before he leaves and sees that it is for sixty tablets. He points out, none too courteously, I might add, that we've made a mistake. He had asked for a ninety day supply. We should have given him a quantity of #180. Note: We've made a mistake. Us. The pharmacy team. The druggist. The stoopnagle with the white jacket who can't count. You know the guy, the one who can't read the prescriptions with the silly handwriting on them. Except that guy didn't make that mistake. Didn't make too many others either. This is the guy whose job it is to catch mistakes. That's right. The job of a pharmacist is to catch the mistakes of others. It is no...

  As reported in The New York Times today, Sunday Sept. 13 th , 2009, Nikki White died not from her lupus but from a horrific health care system that refused to care for her. Every half hour another person dies from lack of care in this country (National Academy of Sciences). And there is no outrage. As Nicholas Kristof writes, every two months as many people die in this country as died in the World Trade Center attack, which resulted in this country spending hundreds of billions of dollars to prevent such an attack from happening again. But we balk at universal health care. No outrage. Christians sit on their hands. Republicans call the President a liar. Fox News spreads misinformation. And no one cares. If you care that Nikki White died needlessly, then you need to do something. Fax a congressman, the president. Something. Anything. Why be part of the problem when you could be part of the solution?