Holy Anarchy: How Chaos at Chain Pharmacies Is Putting Patients at Risk

I needed a break from studying for USMLE Step 3 tonight. This seemed like a fun topic. I mean, who doesn’t like a little anarchy and chaos every once in a while. The caveat is every once in a while, whereby the article describes an incessant push “to do more with less has made medication errors more likely. “I am a danger to the public,” one wrote to a regulator.” We’ve all heard the stories, maybe even happened to us, or maybe even happened to our patients. I mean, ordered Celexa, and patient received Celebrex. I firmly believe IT IS NOT pharmacist’s goals to make these egregious errors, but they do happen. This article is not bashing pharmacists, but it is about:

many pharmacists at companies like CVS, Rite Aid and Walgreens described understaffed and chaotic workplaces where they said it had become difficult to perform their jobs safely, putting the public at risk of medication errors.

            It reminds me of my Army days where we were always trying to do more with less. This article describes competing tasks for pharmacy staff at these pharmacies such as fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies, they said — “all the while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less.” It stands to reason that there will be an increase in errors. Competing interests of the corporation and the patient care emerges. 

            The article describes a survey done of pharmacists in Missouri. It reports

“Of the nearly 1,000 pharmacists who took the survey, 60 percent said they “agree” or “strongly agree” that they “feel pressured or intimidated to meet standards or metrics that may interfere with safe patient care.” About 60 percent of respondents worked for retail chains, as opposed to hospitals or independent pharmacies.”

            The article describes attempted fixes that however, fall short. Items such as limitng the amount of technicians a pharmacist can supervise, allowing technicians who have less training do more tasks to free up the pharmacist etc. Often when an error is reported to a board, action is taken against the pharmacist, an obvious target. It is less common for a company to be scrutinized. That could be a reasonable change to be made. At any rate, just some things to think about on this cold rainy evening. 

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  1 comment for “Holy Anarchy: How Chaos at Chain Pharmacies Is Putting Patients at Risk

  1. Frank Savoretti, JD, MD
    February 8, 2020 at 10:13 am

    Quite right! This is what is also happening to Physicians who work for large organizations, and the Scabs taking their places too. The percentage of Doctors in Private Practice who own and operate their own offices are diminishing yearly. Yet those who read “Authentic Medicine” all know that if one practices the Four A’s: Ability, Availability, Affability and Affordability a Doctor will be busier than the proverbial one armed wallpaper hanger in very shot time and all those “HUGE, UNAFFORDABLE, WAH! WAH! WAH!” loans will be paid off in short order. The new Doctors the system is churning out have been screened to be “Good Corporate Team Players” ie, do what they’re told and shut their mouths. How do I know this? When my son was applying to Medical School in the late 1990’s the MCAT application required the completion of a fifty question form. He answered them and showed me, because I had taught him “Anytime you’re required to sign anything at all it is because it is meant to be used AGAINST you in the future, so show me FIRST!” The questions were a Personality, Psychological Screening. “When you’re a Doctor do you expect to earn $50,00 a year? $100,000 a year? One Million Dollars a year?” and “I prefer to work 1) In a large team of cooperative people 2) A small group 3) Alone” Etc, etc. He answered like the Conservative Libertarian he is. WRONG! “My son you have perfect Grades, you’re getting Mid 30’s on the Kaplan Review MCAT practice exams but with answers like that they will NEVER take you into an American Medical School. You must answer the questions like a Good American Communist: you want to work for free, you love large groups, you love long winded meetings with Administrators and other parasites, etc. Then you have a small chance of getting in.” He got in and we practice together. Our own bosses. No Bulls–t from Administrators. And we have more work than we want.

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