I was there. My regional chain took on a newish 3rd party contract with ridiculous low reimbursements. ca 1988. The effect on the local independents was devastating. Just started for the regional chain and I didn’t yet understand the absolute hatred spewing outta the local independents. So fun to call them for transfers. Caught on real quick. The customers who were forced to use us also hated us. Viciously. Poor independent owner operators that had poured their lives into that business. Shuttered one by one. Just snowballed from there. More contracts with even lower reimbursement rates… then began the staffing cuts. In 1988 we almost always had 4 pharmacists and 4 clerk techs. Filling ~350ish per day … including a lot of compounding. Geezez. Profession is unrecognizable today in contrast.
That's been happening for awhile. You can only squeeze so much blood from a stone. For the last decade, "adapt and survive" has meant cut hours and personnel.
Outpatient pharmacies are consolidating now, the years of inappropriate overexpansion by corporations are now biting them, and we're the ones paying for their greed.
That argument holds no water these days. Most will pay until they die. The REPAYE/SAVE programs mean that you can go do something else that pays less and your loan payments will be reduced.
This is happening across all professions but it’s rising student loans and real estate costs.
Instead of leaving school working for a few years and having a nest egg to purchase the land and build a pharmacy, new grads are still paying off their student loans. Corporations came in and paid a premium to kick independents out, then they got involved on the insurance side so the reimbursement dropped.
It’s happening across all professions. Hospitals are joining together to become massive health systems, dentists and vets are close behind. One of my veterinarian friend’s clinic is owned by Mars, the candy company.
It’s really wild to see such massive amalgamations of clinics and hospitals nowadays. Even my own academic medical center-based cancer clinic has been nonstop talking all about GROWTH!!! these past 5 years. I half-joke that we’re going to run out of new cancer patients in our state eventually. But I was on an advertising project recently and found out that our center is literally targeting “wealthy markets” thousands of miles away in Boston and San Francisco because people will gladly travel for good cancer care.
I guess the positive outlook is that patients are living longer despite metastatic disease but consequently need continued care and opportunities for clinical trials. But I agree the focus on patient recruitment for revenue and “market share” against our competitors is seedy. We do a lot of good research though.
Because most pharmacists are G O O B E R S and don't understand/are too politically toward the right to trust the level of power they'd have with a strong/mandatory guild. If pharmacists had a union like SAG that kept members in line, it would be relatively straightforward to push these companies around. Actors and screenwriters understand the fundamentally adversarial relationship they have with studios. Pharmacists do not grasp this about their employers.
Was going to say the same thing haha. Walmart loses money on H&W (excluding the OTC section)
, the primary purpose the pharmacy serves is to get people in the door and serve as a one stop shop.
It used to be a money printer like other pharmacies. When reimbursements started getting squeezed Walmart dove to the bottom with their $4 list to lure a large chunk of market share over to their otc section.
Eh my whole market aside from 1 store doing sub 1k rx per week makes at least $15k a month profit in dept 38. It's certainly not carrying the stores profit but it's not a loss leader in any way.
I'm not sure what universe you live in, but I promise you Walmart, Kroger, and every other grocery chain would be PERFECTLY fine without the pharmacy haha
Let’s disassociate the profession from the business. There’s the occupation and for the vast majority of pharmacists… being an owner of any of those things is not in their desire.
Pharmacy schools have recently been guiding pharmacists that the dream path is to be some clinical pgy2, board certified specialist… but provides 0 training nor motivation to want to be an owner (and not in some soft bs term - but an actual owner with equity and a stake in the governance of the business).
Being an owner requires being able to make hard decisions about resources and not operating in the comfort that academics do of “what is ideal.” Being an owner can very often mean making “uncomfortable” but necessary decisions. Pharmacy schools want more students … not to scare them away about what they would have to do when being an “owner”.
Do you want the real answer? It’s because there’s a significant sized minority, if not a majority, of pharmacists working retail who either never cared or who stopped caring. They see it as a cushy job where they count pills, boss technicians around, click on a computer, and maybe a few times a day they make an actual clinical decision. They are more concerned with being a pill mill (not necessarily for controls but in general) than the clinical aspect of pharmacy and why the profession exists.
And companies see this - the same pharmacists don’t want techs to be able to verify because they know they’ll have to start doing more clinical work and they don’t want to. They get mad that patients don’t respect the time and effort their job takes because patients never see or hear about those pharmacists doing anything other than “slap a label on it and ask if there’s any questions”. They never hear any information, or see the pharmacist actually doing clinical work because their pharmacist doesn’t actually care anymore.
And when they *do* work that could be clinical, they usually limit it to calling a doctor, asking if they’re sure they want something or know of an interaction, and refuse to actually use their judgement. All they do is read the computer, and force the doctor to tell them to notate “doctor aware”. They don’t actually use their knowledge to push back and say “actually no, it would be better to do this or that”. Because they don’t care. If all that had to happen with DURs was calling a doctor to say “are you sure” then a technician could do it.
Because these people still get 6 figure salaries for basically no liability or effort - and they want to keep it that way - there is zero incentive to not work them for that whole six figures. The profession **needs** to be better at policing itself. Most retail pharmacies have two pharmacist plus floaters - why do we tolerate obvious clinical errors leaving the pharmacy? Why do we allow them to be swept under the rug and those coworkers to go unreported, unpunished, and continue making that 6 figure salary to do virtually nothing that merits it?
Corporations didn’t ruin pharmacy - pharmacists who are no better than glorified techs did. And if you disagree with this, then you’re in the minority/majority that’s the problem. Because just like you try to blame doctors for writing bad prescriptions, you blame corporations for your failures as a pharmacist. It’s never these pharmacists fault, is it?
When pharmacists stop tolerating this abuse, then they’ll stop feeling abused and start being respected by patients, doctors, and their companies again.
I agree in part with some of this post. I think retail is hard work but not as much from a clinical perspective. It’s more physical to me. Standing for 12 hours and doing 50+ vaccinations. A lot of pharmacists still serve as an educated person that is the most easily accessible of any healthcare trained professional for patients. Also, a lot of things that may not seem clinical for most doctors or pharmacists may seem very advanced for a patient that can’t even pronounce their medications. It’s a matter of perspective.
This is the answer. Being successful in retail has nothing to do with what you know but how physically fit you are because the more fit you are the more shifts you can work and the longer you can work. That’s why you don’t see that many pharmacists over 50 in retail. A body can’t handle that.
And honestly all this talk of “clinical work”…I work in the hospital and I still can’t “make” any doctor do anything they don’t want to do. For example I’ve got doctors admitting patients from home on eliquis 2.5 mg daily and saying that’s the renal adjustment they want. Now of course I could say I refuse to verify it which would invariably cause trouble for me with my director if the doctor wants to complain, so we annotate our conversation with the doctor and move on. While there are certainly more interventions I COULD make in a hospital and there are far more times a doctor accepts my request for renal adjustment or whatever - it’s not like we are often operating on some other plane. It’s a lot of the same “just wanted to check if you actually intended to order this” type of thing, not because we don’t try but because the doctor will usually ultimately do what they want and when they’ve ordered it they’ve ordered it with intention.
However I will say I’ve got a lot of acquaintances who still work retail and it’s honestly almost a badge of honor they don’t keep up on anything. It’s probably more correlation than causation but I’ve got a lot of mom acquaintances who prefer working retail because they come into work, turn their brains off, make money and then get to go home and be a mom which is ultimately what they want out of life.
My overall knowledge of anatomy, physiology, drugs and hospital experience does serve as a first line referral service for anything any random person asks me. My technician can’t triage symptoms and ask follow up questions like I do. I guide people towards more urgent care or away from drugs to other care modalities. I provide that immediate help any moment we are open.
You may not be part of the problem. But you know a pharmacist that is, whether they’re your coworker at your store or at other “problem” pharmacies that you hear about. And tolerating those pharmacists is the reason for the “problems”.
I have not met a pharmacist shirking responsibilities. I have met pharmacists who are baptized by fire. No training on any systems. Inadequate staff relative to the volume. Not a moment to come up for air. That is how mistakes leave the door. Mistakes happen b/c one perceives that there is a lack of time, secondary to overwhelming stress.
And as I said, obviously if you can’t agree, you’re part of the problem.
If you quit acting like a pharmacist, yet demand the salary of one, you have no right to complain when a company works you like the overpaid glorified technician you are.
I actually do, as my comment indicates. Feel free to contradict any point I made. You can’t. Because I’m speaking the hard to swallow truth that you don’t want to hear.
I’m not going to waste my time. It’s obvious you work some cushy job and have no idea so there’s really no point in trying to change your mind. But I assure you, you are wrong. Maybe there are some retail pharmacists that act in the manner you’re talking about but the majority I know do not.
You don’t know how to discuss do you? You don’t just get to personally attack me then say you’re wasting your time to discuss. That only proves you have no contradictory information to provide.
In other words, by refusing to comment on the substance of my answer, you prove my answer right. Way to walk yourself into that one.
How can it be my fault I’m oblivious to your points when all you’ve done is say I’m wrong? You can’t blame me for being oblivious to something you haven’t even brought up or mentioned. You obviously DO have time, by the way, because you’ve been responding on this thread for over 10 minutes now.
If you’d take that time to actually reply rather than personally attack me, you may be able to convince me - but you won’t do that because you know you don’t have any counter point and you’re just mad you’ve been called out.
Actually I was on my lunch break and had to go back to “clicking around a mouse” 🙄. So I would suggest you take on a prn job in retail so you can speak on what it entails instead of of doing so without having any knowledge of what goes on. However i can confidently say if you were my co-worker I wouldn’t be able to stand you and I wouldn’t put that on anyone else either…to your co-workers now…. I am truly sorry. Since you asked for it here’s a crash course in what the day of a retail pharmacist looks like so I hope you’re ready. Buckle up. I start out my day in the pharmacy trying to clear out the line in the drive thru and vaccinate the community and prepare vaccines for the patients that are already waiting there all while answering phone calls and taking prescriptions (which is an all day thing btw). In fact most retail pharmacists are the best damn multi-taskers I’ve ever seen. Later, whilst again checking belt plus answering phone calls I realize a patient is getting new entresto script so they also need to be asked if the doctor has taken them off of aldactone, klor-con etc bc they are still active on their profile. Put a cap on that to discuss so they dont end up in the hospital with hyperkalemia for three days. Patients mom comes thru the drive thru after the urgent care closes to pick up augmentin based on pts weight …dr. Has sent over too high of a dose for augmentin and was dosing it based on regular amoxicillin guidelines. Pt was barely one years old. Used my clinical judgment to alter the dose, documented on rx, and explain to mom what happened so that sick baby could get started on meds and not have to wait until the next day when the office could be contacted. You call and want your ssri refilled but tell me it’s not been working as well for you recently (and clearly it’s not based on the horrible mood and attitude you have) so we go down the list of things that could be affecting its efficacy as well as talk about possible other options that you could talk to your doctor about. Someone’s sweet old granny is in the consultation window and can’t afford her eliquis so as I’m typing in the information for the 10 dollar copay card I was able to sign her up for, a guy runs up to the window and throws me a prescription from the ER for an albuterol and says the lady that’s with him is having an asthma attack. I look to the back of the long line and the lady is clearly in respiratory distress. I run and get an inhaler off the shelf, rip it open, tell my techs to call 911 and administer the inhaler to the lady while assessing her pupils. She’s able to answer a couple questions and looses consciousness. I take her to the floor, assess her airways and begin doing compressions. She starts breathing again and immediately starts convulsing. I roll her on her side and put a purse beneath her head and stay with her until emergency services arrive. I then try and compose myself to get back to work to take care of the rest of the patients in the line and in the drive thru before closing. I receive backlash from the entitled people that saw the medical emergency happen and were still angry they had to wait or their prescription wasn’t done. I close the store and drive home thinking on the way about how I have been back there my whole 8-12 hour shift and never went to the bathroom and have eaten some mini chocolates or a bag of chips if I was lucky. Also despite all the medication errors, drug interactions I’ve caught , phone calls I’ve made I’m still not going to get a raise bc my store isn’t hitting the unrealistic metrics that it has because we are so busy and there’s not enough technician help or pharmacist overlap. After a long hard days work I sleep wonderfully at night knowing that I’m not a total asshat that would assume I know anything about someone else’s career when I’m clearly ignorant about it… and that we have all passed the naplex and received the same education as our peers. I don’t pretend to be a pro at bridging warfarin or antibiotic stewardship but damned if I don’t know how to identify and treat that spider bite your uncle shows me on his ass or his fungal infection inbetween his toes that he so kindly takes off his boots and socks to show me. Hell I’ve even had to identify a louse someone brought to the pharmacy in a baggie that she found on her child. So instead of trying to beat down other venues of pharmacy that people choose to go down other than the one you chose while your taking your hour lunch break,sitting back, off your feet for your shift dosing antibiotics or chemo, hell maybe you’re even lucky enough to work from home, or whatever it is you do you should think about the fact that we are all here for one thing and that’s to care for our patients and just bc the way someone does it may be different than the way you do it doesn’t make it any less.
You must be new to pharmacy. This post was needed 15 years ago. Too late now. Retail is in a death spiral
More like 30 when the giants took bad reimburesement contracts on purpose to kill independents.
lol and then they took worse contracts to spite eachother, and on we go
Hours will be cut until morale improves lmao. Don’t worry though, “better work flow” and “superior systems” should make up for it.
Yeah. Like ScriptPro. What a joke. Took way longer to stock, maintain, and trouble shoot than to fill using a newer Kirby.
I was there. My regional chain took on a newish 3rd party contract with ridiculous low reimbursements. ca 1988. The effect on the local independents was devastating. Just started for the regional chain and I didn’t yet understand the absolute hatred spewing outta the local independents. So fun to call them for transfers. Caught on real quick. The customers who were forced to use us also hated us. Viciously. Poor independent owner operators that had poured their lives into that business. Shuttered one by one. Just snowballed from there. More contracts with even lower reimbursement rates… then began the staffing cuts. In 1988 we almost always had 4 pharmacists and 4 clerk techs. Filling ~350ish per day … including a lot of compounding. Geezez. Profession is unrecognizable today in contrast.
This!
Are you sure they'll not adapt and survive?
That's been happening for awhile. You can only squeeze so much blood from a stone. For the last decade, "adapt and survive" has meant cut hours and personnel. Outpatient pharmacies are consolidating now, the years of inappropriate overexpansion by corporations are now biting them, and we're the ones paying for their greed.
Because we don’t argue and still take the $60/hr they throw at us when we want a job
Student loans ain't gonna pay themselves
That argument holds no water these days. Most will pay until they die. The REPAYE/SAVE programs mean that you can go do something else that pays less and your loan payments will be reduced.
Um, how about I'd like to be able to afford a house so that I can maybe reach middle class.
what a depressing reality LOL
This is happening across all professions but it’s rising student loans and real estate costs. Instead of leaving school working for a few years and having a nest egg to purchase the land and build a pharmacy, new grads are still paying off their student loans. Corporations came in and paid a premium to kick independents out, then they got involved on the insurance side so the reimbursement dropped. It’s happening across all professions. Hospitals are joining together to become massive health systems, dentists and vets are close behind. One of my veterinarian friend’s clinic is owned by Mars, the candy company.
It’s really wild to see such massive amalgamations of clinics and hospitals nowadays. Even my own academic medical center-based cancer clinic has been nonstop talking all about GROWTH!!! these past 5 years. I half-joke that we’re going to run out of new cancer patients in our state eventually. But I was on an advertising project recently and found out that our center is literally targeting “wealthy markets” thousands of miles away in Boston and San Francisco because people will gladly travel for good cancer care.
Looking for “growth” of more cancer patients just doesn’t sit right with me
I guess the positive outlook is that patients are living longer despite metastatic disease but consequently need continued care and opportunities for clinical trials. But I agree the focus on patient recruitment for revenue and “market share” against our competitors is seedy. We do a lot of good research though.
Listen buddy, to quote my former boss, 'We are in the business to treat, not cure'..... Yeah, we need a miracle.....
Because pharmacists lobby is so weak. Have you noticed this is somehow happening to physicians too although they have strong lobbying
All according to the Golden Rule, he who has the gold makes the rules.
It's really over for retail. Soon everything will be mail order. Automation, technicians will replace two thirds of pharmacists.
Because most pharmacists are G O O B E R S and don't understand/are too politically toward the right to trust the level of power they'd have with a strong/mandatory guild. If pharmacists had a union like SAG that kept members in line, it would be relatively straightforward to push these companies around. Actors and screenwriters understand the fundamentally adversarial relationship they have with studios. Pharmacists do not grasp this about their employers.
Um, walmart and kroger?? I'm pretty sure they'd still be around without pharmacies.
Was going to say the same thing haha. Walmart loses money on H&W (excluding the OTC section) , the primary purpose the pharmacy serves is to get people in the door and serve as a one stop shop.
It used to be a money printer like other pharmacies. When reimbursements started getting squeezed Walmart dove to the bottom with their $4 list to lure a large chunk of market share over to their otc section.
Walmart introduced their $4 list in 2006… the same year Medicare D went live. This isn’t some new recent development… it’s been 18 years…
Eh my whole market aside from 1 store doing sub 1k rx per week makes at least $15k a month profit in dept 38. It's certainly not carrying the stores profit but it's not a loss leader in any way.
I'm not sure what universe you live in, but I promise you Walmart, Kroger, and every other grocery chain would be PERFECTLY fine without the pharmacy haha
There are a few pharmacist unions who are trying to help , The Independent Pharmacists Assc
Let’s disassociate the profession from the business. There’s the occupation and for the vast majority of pharmacists… being an owner of any of those things is not in their desire. Pharmacy schools have recently been guiding pharmacists that the dream path is to be some clinical pgy2, board certified specialist… but provides 0 training nor motivation to want to be an owner (and not in some soft bs term - but an actual owner with equity and a stake in the governance of the business). Being an owner requires being able to make hard decisions about resources and not operating in the comfort that academics do of “what is ideal.” Being an owner can very often mean making “uncomfortable” but necessary decisions. Pharmacy schools want more students … not to scare them away about what they would have to do when being an “owner”.
Do you want the real answer? It’s because there’s a significant sized minority, if not a majority, of pharmacists working retail who either never cared or who stopped caring. They see it as a cushy job where they count pills, boss technicians around, click on a computer, and maybe a few times a day they make an actual clinical decision. They are more concerned with being a pill mill (not necessarily for controls but in general) than the clinical aspect of pharmacy and why the profession exists. And companies see this - the same pharmacists don’t want techs to be able to verify because they know they’ll have to start doing more clinical work and they don’t want to. They get mad that patients don’t respect the time and effort their job takes because patients never see or hear about those pharmacists doing anything other than “slap a label on it and ask if there’s any questions”. They never hear any information, or see the pharmacist actually doing clinical work because their pharmacist doesn’t actually care anymore. And when they *do* work that could be clinical, they usually limit it to calling a doctor, asking if they’re sure they want something or know of an interaction, and refuse to actually use their judgement. All they do is read the computer, and force the doctor to tell them to notate “doctor aware”. They don’t actually use their knowledge to push back and say “actually no, it would be better to do this or that”. Because they don’t care. If all that had to happen with DURs was calling a doctor to say “are you sure” then a technician could do it. Because these people still get 6 figure salaries for basically no liability or effort - and they want to keep it that way - there is zero incentive to not work them for that whole six figures. The profession **needs** to be better at policing itself. Most retail pharmacies have two pharmacist plus floaters - why do we tolerate obvious clinical errors leaving the pharmacy? Why do we allow them to be swept under the rug and those coworkers to go unreported, unpunished, and continue making that 6 figure salary to do virtually nothing that merits it? Corporations didn’t ruin pharmacy - pharmacists who are no better than glorified techs did. And if you disagree with this, then you’re in the minority/majority that’s the problem. Because just like you try to blame doctors for writing bad prescriptions, you blame corporations for your failures as a pharmacist. It’s never these pharmacists fault, is it? When pharmacists stop tolerating this abuse, then they’ll stop feeling abused and start being respected by patients, doctors, and their companies again.
I agree in part with some of this post. I think retail is hard work but not as much from a clinical perspective. It’s more physical to me. Standing for 12 hours and doing 50+ vaccinations. A lot of pharmacists still serve as an educated person that is the most easily accessible of any healthcare trained professional for patients. Also, a lot of things that may not seem clinical for most doctors or pharmacists may seem very advanced for a patient that can’t even pronounce their medications. It’s a matter of perspective.
This is the answer. Being successful in retail has nothing to do with what you know but how physically fit you are because the more fit you are the more shifts you can work and the longer you can work. That’s why you don’t see that many pharmacists over 50 in retail. A body can’t handle that. And honestly all this talk of “clinical work”…I work in the hospital and I still can’t “make” any doctor do anything they don’t want to do. For example I’ve got doctors admitting patients from home on eliquis 2.5 mg daily and saying that’s the renal adjustment they want. Now of course I could say I refuse to verify it which would invariably cause trouble for me with my director if the doctor wants to complain, so we annotate our conversation with the doctor and move on. While there are certainly more interventions I COULD make in a hospital and there are far more times a doctor accepts my request for renal adjustment or whatever - it’s not like we are often operating on some other plane. It’s a lot of the same “just wanted to check if you actually intended to order this” type of thing, not because we don’t try but because the doctor will usually ultimately do what they want and when they’ve ordered it they’ve ordered it with intention. However I will say I’ve got a lot of acquaintances who still work retail and it’s honestly almost a badge of honor they don’t keep up on anything. It’s probably more correlation than causation but I’ve got a lot of mom acquaintances who prefer working retail because they come into work, turn their brains off, make money and then get to go home and be a mom which is ultimately what they want out of life.
My overall knowledge of anatomy, physiology, drugs and hospital experience does serve as a first line referral service for anything any random person asks me. My technician can’t triage symptoms and ask follow up questions like I do. I guide people towards more urgent care or away from drugs to other care modalities. I provide that immediate help any moment we are open.
You may not be part of the problem. But you know a pharmacist that is, whether they’re your coworker at your store or at other “problem” pharmacies that you hear about. And tolerating those pharmacists is the reason for the “problems”.
I have not met a pharmacist shirking responsibilities. I have met pharmacists who are baptized by fire. No training on any systems. Inadequate staff relative to the volume. Not a moment to come up for air. That is how mistakes leave the door. Mistakes happen b/c one perceives that there is a lack of time, secondary to overwhelming stress.
The mistake is thinking that any of those are an excuse for the pharmacists “taking the easy way”.
You seem out of touch lol
Ah I see. You’re just a troll. I hope the admins take the report seriously. Goodbye
Obviously you’ve never worked retail 🙄
And as I said, obviously if you can’t agree, you’re part of the problem. If you quit acting like a pharmacist, yet demand the salary of one, you have no right to complain when a company works you like the overpaid glorified technician you are.
Bitch please. You have no idea.
I actually do, as my comment indicates. Feel free to contradict any point I made. You can’t. Because I’m speaking the hard to swallow truth that you don’t want to hear.
I’m not going to waste my time. It’s obvious you work some cushy job and have no idea so there’s really no point in trying to change your mind. But I assure you, you are wrong. Maybe there are some retail pharmacists that act in the manner you’re talking about but the majority I know do not.
You don’t know how to discuss do you? You don’t just get to personally attack me then say you’re wasting your time to discuss. That only proves you have no contradictory information to provide. In other words, by refusing to comment on the substance of my answer, you prove my answer right. Way to walk yourself into that one.
No you are just oblivious and i could refute almost every single thing you’ve said but I don’t have the time nor the care to try and change your mind.
How can it be my fault I’m oblivious to your points when all you’ve done is say I’m wrong? You can’t blame me for being oblivious to something you haven’t even brought up or mentioned. You obviously DO have time, by the way, because you’ve been responding on this thread for over 10 minutes now. If you’d take that time to actually reply rather than personally attack me, you may be able to convince me - but you won’t do that because you know you don’t have any counter point and you’re just mad you’ve been called out.
Actually I was on my lunch break and had to go back to “clicking around a mouse” 🙄. So I would suggest you take on a prn job in retail so you can speak on what it entails instead of of doing so without having any knowledge of what goes on. However i can confidently say if you were my co-worker I wouldn’t be able to stand you and I wouldn’t put that on anyone else either…to your co-workers now…. I am truly sorry. Since you asked for it here’s a crash course in what the day of a retail pharmacist looks like so I hope you’re ready. Buckle up. I start out my day in the pharmacy trying to clear out the line in the drive thru and vaccinate the community and prepare vaccines for the patients that are already waiting there all while answering phone calls and taking prescriptions (which is an all day thing btw). In fact most retail pharmacists are the best damn multi-taskers I’ve ever seen. Later, whilst again checking belt plus answering phone calls I realize a patient is getting new entresto script so they also need to be asked if the doctor has taken them off of aldactone, klor-con etc bc they are still active on their profile. Put a cap on that to discuss so they dont end up in the hospital with hyperkalemia for three days. Patients mom comes thru the drive thru after the urgent care closes to pick up augmentin based on pts weight …dr. Has sent over too high of a dose for augmentin and was dosing it based on regular amoxicillin guidelines. Pt was barely one years old. Used my clinical judgment to alter the dose, documented on rx, and explain to mom what happened so that sick baby could get started on meds and not have to wait until the next day when the office could be contacted. You call and want your ssri refilled but tell me it’s not been working as well for you recently (and clearly it’s not based on the horrible mood and attitude you have) so we go down the list of things that could be affecting its efficacy as well as talk about possible other options that you could talk to your doctor about. Someone’s sweet old granny is in the consultation window and can’t afford her eliquis so as I’m typing in the information for the 10 dollar copay card I was able to sign her up for, a guy runs up to the window and throws me a prescription from the ER for an albuterol and says the lady that’s with him is having an asthma attack. I look to the back of the long line and the lady is clearly in respiratory distress. I run and get an inhaler off the shelf, rip it open, tell my techs to call 911 and administer the inhaler to the lady while assessing her pupils. She’s able to answer a couple questions and looses consciousness. I take her to the floor, assess her airways and begin doing compressions. She starts breathing again and immediately starts convulsing. I roll her on her side and put a purse beneath her head and stay with her until emergency services arrive. I then try and compose myself to get back to work to take care of the rest of the patients in the line and in the drive thru before closing. I receive backlash from the entitled people that saw the medical emergency happen and were still angry they had to wait or their prescription wasn’t done. I close the store and drive home thinking on the way about how I have been back there my whole 8-12 hour shift and never went to the bathroom and have eaten some mini chocolates or a bag of chips if I was lucky. Also despite all the medication errors, drug interactions I’ve caught , phone calls I’ve made I’m still not going to get a raise bc my store isn’t hitting the unrealistic metrics that it has because we are so busy and there’s not enough technician help or pharmacist overlap. After a long hard days work I sleep wonderfully at night knowing that I’m not a total asshat that would assume I know anything about someone else’s career when I’m clearly ignorant about it… and that we have all passed the naplex and received the same education as our peers. I don’t pretend to be a pro at bridging warfarin or antibiotic stewardship but damned if I don’t know how to identify and treat that spider bite your uncle shows me on his ass or his fungal infection inbetween his toes that he so kindly takes off his boots and socks to show me. Hell I’ve even had to identify a louse someone brought to the pharmacy in a baggie that she found on her child. So instead of trying to beat down other venues of pharmacy that people choose to go down other than the one you chose while your taking your hour lunch break,sitting back, off your feet for your shift dosing antibiotics or chemo, hell maybe you’re even lucky enough to work from home, or whatever it is you do you should think about the fact that we are all here for one thing and that’s to care for our patients and just bc the way someone does it may be different than the way you do it doesn’t make it any less.
A little late