Metrics: How not to practice pharmacy

David Stanley

I remember the day the clocks showed up on our computer screens. “Nothing to worry about,” the district manager for the chain I was working for at the time assured us. “They’re just using it to collect some data.” To hear her describe it, this newly installed feature, designed to measure how fast pharmacists were getting prescriptions out the door, was more like an unwanted app that came preinstalled on your smartphone. “They’ll never use it to actually rate performance.”

She actually said that. And within a couple of years we were working under a guarantee of three prescriptions in 15 minutes, and the district managers were now cracking the whip on “problem stores” that were not churning out the pills fast enough.

It's like a plague

For most people reading this, I’m not telling you anything you don’t already know. “What you can measure, you can manage” has become the mantra of modern business, and nothing you can’t slap a number on, like professional judgment, seems to matter. 

What you may not be aware of, however, is how this type of numbers mania has now spread to the very top of the medical pyramid. A recent online article for The Atlantic tells the story of “Tony,” an emergency room physician, who recently left his job partly because he was frustrated by his hospital’s use of patient satisfaction scores in evaluating doctors’ performance.

Tony and his colleagues felt they were under a great deal of pressure to improve these scores. According to the article, “physicians can be hired, fired, promoted, and compensated based in part on their patient satisfaction scores,” which could be lowered by input from people like an angry drug-seeker denied a narcotic prescription that would not have been medically justified. A doctor using his judgment to deny a drug-seeker another Vicodin prescription could be doing damage to his career, same as a pharmacist in my old company who took the time to clarify an ambiguous prescription and cost his store a gift card.

This is what it has come to. Good medicine cannot be quantified, and therefore in some quarters it has no value, while a poorly chosen metric ends up contributing to the flood of narcotics drowning this nation.

I can’t help but wonder: If we as a profession had risen up and said “NO!” the first time a clock appeared on our computer screen, could we have put a stop to this? What if Tony could have been evaluated by clinical outcomes? What if we had concentrated on giving flu vaccinations to those who most need one, instead of striving to meet an arbitrary shot quota?

But we didn’t, and by the time I left the chain world, we were expected to put 10 flu shots a day into any arms we could find, and we could never have more than five labels printed at a time, because to have any more would mess up our numbers.

Head for the hills

It’s not too late to unchain yourself from metrics mania, although it may be harder to accomplish than it used to be.

You’ll probably have to leave your job, the way Tony and I have done, and strike out on your own in search of a corner of the medical world that still values intangible factors - or at least picks something to measure that actually improves patient care.

When I see a drug chain that emphasizes giving flu shots to the elderly, or that congratulates a pharmacist who refused to fill prescriptions from the out-of-state pill mill, I’ll know we’re making progress.

My gut tells me what’s far more likely to happen, though, is that sometime soon another little icon will appear on your computer screen, along with an assurance that it’s nothing important, so don’t give it another thought.

It’ll be up to you to decide what to do next. Tony and I will be watching, and hoping.   

David Stanley is a pharmacy owner, blogger, and professional writer in northern California. E-mail him at drugmonkeyrph@gmail.com.