Why I wrote Pharmacy Exposed

In My View  Dennis Miller, RPh

Over the last 10 years, I have written several Viewpoint columns critical of pharmacy working conditions. As a result, many pharmacists have e-mailed me to say that I should stop preaching to the choir and, instead, try to reach an audience beyond pharmacists, an audience that doesn’t understand the absurdity of operating pharmacies based on the McDonald’s fast-food model. Under this model, pharmacists have little choice but to sling out potentially deadly medications at a speed that makes mistakes inevitable.

In more than 750 pages written over nearly 30 years, Pharmacy Exposed: 1,000 Things That Can Go Deadly Wrong at the Drugstore is a massive indictment of the McDonaldization of pharmacy. Pharmacy Exposed is the book the big chains don’t want your customers to read. In the world of pharmacy, it will upset many people in positions of power, including those at the big chain drugstores, at state boards of pharmacy, and at this nation’s many pharmacy schools. I hope that it becomes a paradigm-shifting book.

The truth of “McPharmacy”

Many, many pharmacists are disillusioned with the profession and refuse to recommend pharmacy as a career for their children. They would never have chosen pharmacy as a career, they say, had they known what conditions in “McPharmacy” are like.

This is a reckless system that treats powerful prescription drugs as if they are no different from any other consumer product. The big drugstore chains run their operations as if pharmacists dispense nothing more hazardous than a Big Mac or a Whopper. Somehow McDonald’s and Burger King are able to provide adequate staff to dispense hamburgers, but the big pharmacy chains are unable or unwilling to provide adequate staff for the dispensing of a far more serious - and potentially dangerous - product.

Rolling the dice

Pharmacy Exposed discusses the issues chain pharmacists have been afraid to speak out about because they fear jeopardizing their jobs. Too many pharmacists today feel that the McDonald’s-based chain-drugstore model has been disastrous for public safety and for the profession of pharmacy. Pharmacists are disgusted with what they see as the unconscionable way in which the big chains jeopardize the safety of our customers. Pharmacists are furious that the current system cavalierly jeopardizes our licenses with every prescription we dispense.

Many pharmacists feel they are rolling the dice every day they go to work. Our constant companion is the fear that our next mistake will result in the death or serious injury of a customer. Pharmacists go home at night crossing their fingers and wondering whether all the prescriptions they filled that day were done properly. Pharmacists say to themselves something like, “Mrs. Smith was in today, but I don’t even remember checking her prescriptions.”

Speed kills

I have included in Pharmacy Exposed a description of 50 major court settlements arising from pharmacy mistakes. In 34 of these cases, the mistake resulted in a jury award of at least a million dollars and/or resulted in the death of a patient.

Not surprisingly, many pharmacists privately welcome multimillion-dollar awards. I’ve heard several pharmacists say things like “I hope the media coverage embarrasses the chains into providing adequate staffing so that pharmacy mistakes aren’t inevitable.”

Pharmacists feel that that the chains value their speed in filling prescriptions much more highly than they value their knowledge of drugs. Many pharmacists believe that the chains have made the cold calculation that it is more profitable to sling out prescriptions at lightning speed and pay customers harmed by mistakes than it is to provide adequate staffing so that mistakes are a rarity. Understaffing increases pharmacy profitability, but it also increases the frequency of serious errors.

Pharmacy mistakes are a horrific yet predictable consequence of the chains’ obsession with the bottom line. It appears that cost-cutting - not patient safety - is the core guiding principle.

I hope that Pharmacy Exposed inflames public opinion and forces change. Significant change will occur only when the public demands an end to fast-food pharmacy.

Dennis Millleris a retired chain-store pharmacist living in Deray Beach, Fla. He welcomes feedback at dmiller1952@aol.com. Pharmacy Exposed is available at Amazon.com.